Surgical devices with intracorporeal elbow joint

ABSTRACT

Surgical devices are disclosed herein that generally include an intracorporeal elbow joint to facilitate translational movement of an end effector while allowing a body portion of the surgical device and a trocar or working channel through which the device is inserted to be maintained in a fixed angular orientation relative to the patient. This allows a plurality of such devices to be used effectively with a single incision or access device. Such devices also generally provide end effector movement with six degrees of freedom, while maintaining a mechanical linkage between the user and the end effector and while mimicking and/or mirroring natural user movement. Various methods related to such devices are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/937,448 filed on Nov. 10, 2015 and entitled “Surgical Devices withIntracorporeal Elbow Joint” (now U.S. Pat. No. 9,955,988), which is acontinuation of U.S. application Ser. No. 13/309,856 filed on Dec. 2,2011 and entitled “Surgical Devices with Intracorporeal Elbow Joint”(now U.S. Pat. No. 9,211,159), which are hereby incorporated byreference in their entireties.

FIELD

The present invention relates to methods and devices for controllingmovement of an end effector assembly on a distal end of a surgicaldevice.

BACKGROUND

Minimally invasive surgery (MIS) is often preferred over traditionalopen surgery due to the reduced post-operative recovery time and minimalscarring associated therewith. Laparoscopic surgery is one type of MISprocedure in which one or more small incisions are formed in the abdomenand a trocar is inserted through each incision to form a pathway thatprovides access to the abdominal cavity. The trocar is used to introducevarious instruments and tools into the abdominal cavity, as well as toprovide insufflation to elevate the abdominal wall above the organs. Theinstruments and tools can be used to engage and/or treat tissue in anumber of ways to achieve a diagnostic or therapeutic effect. Endoscopicsurgery is another type of MIS procedure in which elongate flexibleshafts are introduced into the body through a natural orifice.

Conventional MIS devices include a handle, an elongate shaft, and an endeffector at the distal end. Motion of the end effector is typicallylimited to four degrees of freedom: (1) rotation of the end effectorabout its longitudinal axis, which is achieved by rotating the entiredevice relative to the trocar, (2) in-out translational movement of theend effector, which is achieved by sliding the entire devicelongitudinally relative to the trocar, (3) up-down translationalmovement of the end effector, which is achieved by angling the deviceand trocar relative to the patient, and (4) left-right translationalmovement of the end effector, which is also achieved by angling thedevice and trocar relative to the patient. Some MIS devices also includea wrist joint proximal to the end effector which provides two additionaldegrees of freedom: (5) up-down pivot movement of the end effector and(6) left-right pivot movement of the end effector.

Conventional MIS devices suffer from a number of disadvantages. Forexample, the trocar angling that is required to achieve up-downtranslational movement and left-right translational movement of the endeffector places a significant amount of strain on the incision in whichthe trocar is inserted, which can cause increased trauma and inadvertentrelease of insufflation gas. Moreover, this trocar angling makes itdifficult if not impossible to operate effectively with two devicesinserted into the same incision, or inserted into incisions that are inclose proximity to each other, as the elongate shafts of the two devicesinterfere with one another when the devices are angled. Thus, in orderto maintain optimum maneuverability, multiple incisions are used whenmultiple conventional MIS devices must be employed simultaneously, whichfurther increases patient trauma and scarring.

By way of further example, controlling conventional MIS systems can becumbersome, and motion error introduced by such devices makes endeffector movement seem unnatural to the user. In addition, shear forcesassociated with conventional MIS instruments can be high, leading toincreased user fatigue.

Various robotic systems have been developed to assist in MIS procedures.Robotic systems generally operate by translating user motion of a masterdevice into control signals for driving a plurality of servos. Theservos in turn selectively actuate a slave device to impart the desiredmotion thereto. One drawback with robotic systems, however, is the lossof a direct mechanical linkage between the user and the tissue or objectbeing manipulated. With robotic systems, there can be no true forcefeedback given to the user. Another drawback is the high expenseassociated with such systems. Furthermore, robotic systems suffer fromthe same trocar angling requirements as conventional MIS devices.

Accordingly, there remains a need for improved methods and devices forcontrolling movement of an end effector assembly on a distal end of asurgical device.

SUMMARY

Surgical devices are disclosed herein that generally include anintracorporeal elbow joint to facilitate translational movement of anend effector while allowing a body portion of the surgical device and atrocar or working channel through which the device is inserted to bemaintained in a fixed angular orientation relative to the patient. Thisallows a plurality of such devices to be used effectively with a singleincision or access device. Such devices also generally provide endeffector movement with six degrees of freedom, while maintaining amechanical linkage between the user and the end effector and whilemimicking and/or mirroring natural user movement. Various methodsrelated to such devices are also disclosed.

In one aspect, a surgical device is provided that includes an elongatebody having proximal and distal ends and a longitudinal axis, a masterassembly coupled to the proximal end of the elongate body, the masterassembly including a handle, and a slave assembly coupled to the distalend of the elongate body, the slave assembly including an end effector.Heave and sway of the handle relative to the longitudinal axis of theelongate body can cause corresponding heave and sway of the end effectorrelative to the longitudinal axis of the elongate body.

In some embodiments, the master assembly can be coupled to the elongatebody by a proximal elbow assembly and the slave assembly can be coupledto the elongate body by a distal elbow assembly, the proximal and distalelbow assemblies being coupled to one another by a plurality of cables.The device can also include at least one mechanical linkage extendingbetween the master assembly and the slave assembly. Actuation of themaster assembly can cause corresponding actuation of the slave assembly.

Heave and sway of the slave component can be scaled in magnituderelative to heave and sway of the master component. Heave and sway ofthe master component can mimicked or mirrored by corresponding heave andsway of the slave component.

The device can also include a linear bearing in which the elongate bodyis slidably and rotatably received such that the elongate body can surgeand roll with respect to the linear bearing. The device can also includea locking member slidable along the elongate body between a firstposition in which heave and sway of the master assembly is restrained bythe locking member and a second position in which heave and sway of themaster assembly is not restrained by the locking member.

In some embodiments, yaw of the handle pulls at least one of a pluralityof yaw cables to cause corresponding yaw of the end effector, pitch ofthe handle pulls at least one of a plurality of pitch cables to causecorresponding pitch of the end effector, and heave and sway of thehandle pulls at least one of a plurality of elbow cables to causecorresponding heave and sway of the end effector. The master assemblycan include a central pulley system comprising a first pulley axle and asecond pulley axle, the second pulley axle being perpendicularlyoriented relative to the first pulley axle. Each of the plurality of yawcables can wrap around one pulley disposed on the first pulley axle andone pulley disposed on the second pulley axle. Each of the plurality ofpitch cables can wrap around two pulleys disposed on the first pulleyaxle and two pulleys disposed on the second pulley axle. Pulleys on thefirst and second pulley axles around which the yaw cables are wrappedcan have a diameter that is approximately two times greater than adiameter of pulleys on the first and second pulley axles around whichthe pitch cables are wrapped.

The central pulley system can include a plurality of pulleys, each ofthe plurality of pulleys having first and second cable tracks extendingcircumferentially therearound. Each of the plurality of yaw cables andeach of the plurality of pitch cables can be wrapped at least 225degrees around at least one pulley of the central pulley system.

In another aspect, a surgical device is provided that includes an endeffector having proximal and distal ends and a distal wrist assemblycoupled to the proximal end of the end effector, the distal wristassembly having a first pivot joint about which the end effector yawsand a second pivot joint about which the end effector pitches. Thedevice also includes a distal elbow assembly coupled to a proximal endof the distal wrist assembly, the distal elbow assembly having a firstelbow joint about which the distal wrist assembly heaves and sways. Thedevice further includes a handle assembly having proximal and distalends and first and second handle levers, and a proximal wrist assemblycoupled to the distal end of the handle assembly, the proximal wristassembly having a third pivot joint about which the handle assembly yawsand a fourth pivot joint about which the handle assembly pitches. Thedevice also includes a proximal elbow assembly coupled to a distal endof the proximal wrist assembly, the proximal elbow assembly having asecond elbow joint about which the proximal wrist assembly heaves andsways. An elongate body is disposed between the proximal and distalelbow assemblies. The device also includes a plurality of yaw cablesextending from the handle assembly to the end effector, a plurality ofpitch cables extending from the proximal wrist assembly to the distalwrist assembly, and a plurality of elbow cables extending from theproximal elbow assembly to the distal elbow assembly.

Yaw of the handle assembly pulls at least one of the yaw cables to causecorresponding yaw of the end effector, pitch of the handle assemblypulls at least one of the pitch cables to cause corresponding pitch ofthe end effector, and heave and sway of the handle assembly pulls atleast one of the elbow cables to cause corresponding heave and sway ofthe end effector.

Yaw of the handle assembly can be mimicked or mirrored by correspondingyaw of the end effector. The corresponding yaw of the end effector canbe scaled in magnitude relative to the yaw of the handle assembly. Pitchof the handle assembly can be mimicked or mirrored by the correspondingpitch of the end effector. The corresponding pitch of the end effectorcan be scaled in magnitude relative to the pitch of the handle assembly.Heave and sway of the handle assembly can be mimicked or mirrored by thecorresponding heave and sway of the end effector.

In some embodiments, movement of the first and second handle leverstowards one another pulls at least one of the yaw cables to causecorresponding movement of first and second jaws of the end effectortowards one another. The first and second handle levers can pivot aboutat least one handle axis, the at least one handle axis being offset froma pivot axis of the third pivot joint and a pivot axis of the fourthpivot joint.

The device can also include a frame assembly that couples the elongatebody to the proximal elbow assembly, the frame assembly including aplurality of pulleys for guiding the plurality of yaw cables, theplurality of pitch cables, and the plurality of elbow cablestherethrough. The device can also include a linear bearing in which theelongate body is slidably and rotatably received such that the elongatebody can surge and roll with respect to the linear bearing.

In some embodiments, each of the plurality of elbow cables includes afirst end coupled to a first attachment point within the proximal elbowassembly and a second end coupled to a second attachment point withinthe distal elbow assembly, the first and second attachment points beingoffset 180 degrees from one another. Each of the plurality of elbowcables can be coupled to a corresponding tension adjustment screwthreadably received in a tension plate of the proximal elbow assembly.

The device can also include a plurality of cable braces, each of theplurality of cable braces being coupled to a respective one of theplurality of elbow cables at two or more points, each of the pluralityof braces being less susceptible to stretching than the plurality ofelbow cables. The device can also include a locking member slidablealong the elongate body between a first position in which movement ofthe proximal elbow assembly is restrained by the locking member and asecond position in which movement of the proximal elbow assembly is notrestrained by the locking member.

The proximal wrist assembly can include a central pulley system having afirst pulley axle and a second pulley axle, the second pulley axle beingperpendicularly oriented relative to the first pulley axle. Each of theplurality of yaw cables can wrap around one pulley disposed on the firstpulley axle and one pulley disposed on the second pulley axle. Each ofthe plurality of pitch cables can wrap around two pulleys disposed onthe first pulley axle and two pulleys disposed on the second pulleyaxle. Pulleys on the first and second pulley axles around which the yawcables are wrapped can have a diameter that is approximately two timesgreater than a diameter of pulleys on the first and second pulley axlesaround which the pitch cables are wrapped. The central pulley system caninclude a plurality of pulleys, each of the plurality of pulleys havingfirst and second cable tracks extending circumferentially therearound.Each of the plurality of yaw cables and each of the plurality of pitchcables can be wrapped at least 225 degrees around at least one pulley ofthe central pulley system. The handle assembly can include a pluralityof handle pulleys, each of the plurality of handle pulleys having aterminal end of a respective yaw cable fixedly attached thereto.

In another aspect, a surgical device is provided that includes an endeffector having proximal and distal ends, a distal wrist assemblycoupled to the proximal end of the end effector, the distal wristassembly having a first pivot joint about which the end effector yawsand a second pivot joint about which the end effector pitches, and ahandle assembly having proximal and distal ends and first and secondhandle levers. The device also includes a proximal wrist assemblycoupled to the distal end of the handle assembly, the proximal wristassembly having a third pivot joint about which the handle assembly yawsand a fourth pivot joint about which the handle assembly pitches, and anelongate body disposed between the proximal and distal wrist assemblies.The device also includes a plurality of yaw cables extending from thehandle assembly to the end effector and a plurality of pitch cablesextending from the proximal wrist assembly to the distal wrist assembly.Yaw of the handle assembly pulls at least one of the yaw cables to causecorresponding yaw of the end effector, and pitch of the handle assemblypulls at least one of the pitch cables to cause corresponding pitch ofthe end effector.

In another aspect, a surgical device is provided that includes aproximal elbow assembly that includes first and second retainerhousings, a first plurality of rods extending between and pivotallycoupled to the first and second retainer housings, and a first platedisposed between the first and second retainer housings, the first platehaving a plurality of openings through which the first plurality of rodsare respectively received. The device also includes a distal elbowassembly that includes third and fourth retainer housings, a secondplurality of rods extending between and pivotally coupled to the thirdand fourth retainer housings, and a second plate disposed between thethird and fourth retainer housings, the second plate having a pluralityof openings through which the second plurality of rods are respectivelyreceived. The device also includes an elongate body extending betweenthe proximal and distal elbow assemblies, and a plurality of cablesextending from the first plate, through the elongate body, to the secondplate. Translational movement of the first retainer housing relative tothe second retainer housing is transmitted through the plurality ofcables to cause translational movement of the fourth retainer housingrelative to the third retainer housing.

The device can include a handle coupled to the first retainer housingand an end effector coupled to the fourth retainer housing. The devicecan also include a proximal wrist assembly disposed between the handleand the first retainer housing, the proximal wrist assembly including afirst pivot joint about which yaw of the handle can be adjusted relativeto the first retainer housing and a second pivot joint about which pitchof the handle can be adjusted relative to the first retainer housing.The device can also include a distal wrist assembly disposed between theend effector and the fourth retainer housing, the distal wrist assemblyincluding a third pivot joint about which yaw of the end effector can beadjusted relative to the fourth retainer housing and a fourth pivotjoint about which pitch of the end effector can be adjusted relative tothe fourth retainer housing.

In some embodiments, each of the plurality of cables attaches to anattachment point on the first plate and an attachment point on thesecond plate, the attachment point on the first plate being offset 180degrees from the attachment point on the second plate.

In another aspect, an elbow assembly is provided that includes aproximal retainer housing having a first plurality of concavities formedtherein, a distal retainer housing having a second plurality ofconcavities formed therein, a proximal elbow plate positioned betweenthe proximal and distal retainer housings, the proximal elbow platehaving a first plurality of openings formed therethrough, and a distalelbow plate positioned between the proximal and distal retainerhousings, the distal elbow plate having a second plurality of openingsformed therethrough. The elbow assembly also includes a torque tubeextending between and being rigidly coupled to the proximal and distalelbow plates. The elbow assembly also includes a plurality of elongaterods, each of the plurality of rods extending through a correspondingone of the first plurality of openings and a corresponding one of thesecond plurality of openings, having a proximal end that is pivotallyreceived within a corresponding one of the first plurality ofconcavities, and having a distal end that is pivotally received within acorresponding one of the second plurality of concavities.

In some embodiments, the proximal and distal ends of each of theplurality of rods are conical. The elbow assembly can also include aproximal retainer insert sized to be received within the proximalretainer housing and having a plurality of through holes formed thereinthrough which control cables can be routed. The elbow assembly can alsoinclude a distal retainer insert sized to be received within the distalretainer housing and having a plurality of through holes formed thereinthrough which control cables can be routed.

The elbow assembly can also include a cable tension plate having aplurality of openings formed therethrough, the plurality of rodsextending through the plurality of openings. A plurality of tensionadjustment members can be mounted to the cable tension plate.

In another aspect, an end effector assembly is provided that includesfirst and second major jaws pivotally coupled to each other about afirst pivot joint, and first and second minor jaws pivotally coupled toeach other about a second pivot joint. A distal end of the first minorjaw is pivotally coupled to the first major jaw and a distal end of thesecond minor jaw is pivotally coupled to the second major jaw.

In some embodiments, closure of the first and second major jaws at afirst rate causes closure of the first and second minor jaws at a secondrate that is greater than the first rate. The first major jaw caninclude a first recess sized to receive the first minor jaw, and/or thesecond major jaw can include a second recess sized to receive the secondminor jaw. The first and second major jaws can be positioned in a closedconfiguration in which the first and second minor jaws are completelyreceived within the first and second recesses.

In another aspect, a surgical method is provided that includes insertinga slave component of a surgical device into a body cavity, fixing anangular orientation of a body portion of the surgical device relative tothe body cavity, and, while said angular orientation remains fixed,heaving and swaying a master component of the surgical device relativeto the body portion, thereby causing corresponding heaving and swayingmovement of the slave component relative to the body portion.

The method can also include surging the body portion to surge the slavecomponent and/or rolling the body portion to roll the slave component.The method can also include yawing the master component relative to thebody portion to yaw the slave component relative to the body portionand/or pitching the master component relative to the body portion topitch the slave component relative to the body portion. The method canalso include squeezing first and second handle levers of the mastercomponent together to cause first and second jaws of the slave componentto move towards one another.

In some embodiments, movement of the master component induces scaledmovement of the slave component. The method can also includearticulating a wrist joint of the master component to control pitchingand yawing movement of the slave component and/or articulating an elbowjoint of the master component to control heaving and swaying movement ofthe slave component. The method can also include applying a pullingforce to at least one wrist cable extending through the surgical deviceto induce yaw movement of the slave component, and/or applying a pullingforce to at least one wrist cable extending through the surgical deviceto induce pitch movement of the slave component. The method can alsoinclude applying a pulling force to at least one elbow cable extendingthrough the surgical device to induce heave movement of the slavecomponent, and/or applying a pulling force to at least one elbow cableextending through the surgical device to induce sway movement of theslave component. The method can also include applying a pulling force toat least one wrist cable extending through the surgical device toactuate the slave component.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is an illustration of the six degrees of freedom of a rigid body;

FIG. 2A is a perspective view of one embodiment of a surgical device;

FIG. 2B is a perspective exploded view of the surgical device of FIG.2A;

FIG. 2C is a perspective view of the surgical device of FIG. 2A insertedthrough a surgical access device and coupled to a frame;

FIG. 2D is a side view of the surgical device of FIG. 2A in anarticulated configuration;

FIG. 2E is a bottom view of the surgical device of FIG. 2A in the samearticulated configuration as in FIG. 2D;

FIG. 2F is a perspective view of the surgical device of FIG. 2A in thesame articulated configuration as in FIGS. 2D-2E;

FIG. 3A is a perspective view of one embodiment of a distal wristassembly;

FIG. 3B is an exploded perspective view of the distal wrist assembly ofFIG. 3A;

FIG. 3C is a side view of the distal wrist assembly of FIG. 3A;

FIG. 3D is a top view of the distal wrist assembly of FIG. 3A;

FIG. 4A is a perspective view of one embodiment of a distal elbowassembly;

FIG. 4B is an exploded perspective view of the distal elbow assembly ofFIG. 4A;

FIG. 4C is a side view of the distal elbow assembly of FIG. 4A;

FIG. 4D is a top view of the distal elbow assembly of FIG. 4A;

FIG. 5 is a perspective view of one embodiment of a body assembly;

FIG. 6A is a perspective view of one embodiment of a proximal elbowassembly;

FIG. 6B is an exploded perspective view of the proximal elbow assemblyof FIG. 6A;

FIG. 6C is a side view of the proximal elbow assembly of FIG. 6A;

FIG. 6D is a top view of the proximal elbow assembly of FIG. 6A;

FIG. 7A is a perspective view of one embodiment of a proximal wristassembly;

FIG. 7B is an exploded perspective view of the proximal wrist assemblyof FIG. 7A;

FIG. 7C is a side view of the proximal wrist assembly of FIG. 7A;

FIG. 7D is a top view of the proximal wrist assembly of FIG. 7A;

FIG. 8 is an exploded perspective view of the central pulley system ofthe proximal wrist assembly of FIG. 7A;

FIG. 9A is a side view of one embodiment of a pulley of the centralpulley system of FIG. 8;

FIG. 9B is a perspective view of one embodiment of a major pulley andone embodiment of a minor pulley of the central pulley system of FIG. 8;

FIG. 10A is a perspective view from above of the proximal pulley systemof the proximal wrist assembly of FIG. 7A;

FIG. 10B is a perspective view from below of the proximal pulley systemof the proximal wrist assembly of FIG. 7A;

FIG. 10C is an exploded perspective view from above of the proximalpulley system of the proximal wrist assembly of FIG. 7A;

FIG. 11A is a side view of one embodiment of an idler pulley assembly ofthe proximal pulley system of FIG. 10A;

FIG. 11B is an exploded perspective view of the idler pulley assembly ofFIG. 11A;

FIG. 12A is a perspective view of one embodiment of a handle assembly;

FIG. 12B is an exploded perspective view of the handle assembly of FIG.12A;

FIG. 12C is a side view of the handle assembly of FIG. 12A;

FIG. 12D is a top view of the handle assembly of FIG. 12A;

FIG. 13A is a perspective view of one embodiment of a handle pulley ofthe handle assembly of FIG. 12A;

FIG. 13B is a top view of the handle pulley of FIG. 13A;

FIG. 14A is a perspective view of the distal path of a first wristcable;

FIG. 14B is a perspective view of the proximal path of the first wristcable of FIG. 14A;

FIG. 15A is a perspective view of the distal path of a second wristcable;

FIG. 15B is a perspective view of the proximal path of the second wristcable of FIG. 15A;

FIG. 16A is a perspective view of the distal path of a third wristcable;

FIG. 16B is a perspective view of the proximal path of the third wristcable of FIG. 16A;

FIG. 17A is a perspective view of the distal path of a fourth wristcable;

FIG. 17B is a perspective view of the proximal path of the fourth wristcable of FIG. 17A;

FIG. 18A is a perspective view of the distal path of a fifth wristcable;

FIG. 18B is a perspective view of the proximal path of the fifth wristcable of FIG. 18A;

FIG. 19A is a perspective view of the distal path of a sixth wristcable;

FIG. 19B is a perspective view of the proximal path of the sixth wristcable of FIG. 19A;

FIG. 20A is a perspective view of the distal paths of the first throughsixth wrist cables of FIGS. 14A-19B;

FIG. 20B is a perspective view of the proximal paths of the firstthrough sixth wrist cables of FIGS. 14A-19B;

FIG. 21A is a perspective schematic view of the path of a first elbowcable;

FIG. 21B is a perspective schematic view of the path of a second elbowcable;

FIG. 21C is a perspective schematic view of the path of a third elbowcable;

FIG. 22 is a side schematic view of the distal elbow assembly of FIG.4A, the proximal elbow assembly of FIG. 6A, and the elbow cables ofFIGS. 21A-21C;

FIG. 23 is a cross-sectional side view of a cable and one exemplaryembodiment of an anti-stretch brace;

FIG. 24 is a perspective view of the surgical device of FIG. 2A, shownwith a locking mechanism;

FIG. 25A is a side view of the surgical device of FIG. 2A, shown with aframe assembly;

FIG. 25B is a perspective view of the frame assembly of FIG. 25A; and

FIG. 25C is a perspective view of the frame assembly of FIG. 25A withone C-shaped side plate removed.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Terminology

There are a number of ways in which to describe an object's position andorientation in space. For example, the position and orientation of anobject can be characterized in terms of the object's degrees of freedom.The degrees of freedom of an object are the set of independent variablesthat completely identify the object's position and orientation. As shownin FIG. 1, the six degrees of freedom of a rigid body with respect to aparticular Cartesian reference frame can be represented by threetranslational (position) variables (e.g., surge, heave, and sway) and bythree rotational (orientation) variables (e.g., roll, pitch, and yaw).

For convenience of description, surge is sometimes described herein astranslational movement in an “in” direction or an “out” direction, heaveis sometimes described as translational movement in an “up” direction ora “down” direction, and sway is sometimes described as translationalmovement in a “left” direction or a “right” direction. Likewise, roll issometimes described herein as rotation about a longitudinal axis, pitchis sometimes described as pivoting in the up direction or the downdirection, and yaw is sometimes described as pivoting in the leftdirection or the right direction. An exemplary mapping of the in, out,up, down, left, and right directions to a surgical device is shown inFIG. 2A. This mapping is generally used throughout the description thatfollows, for example to describe the relative positioning of componentsof the device (e.g., “upper,” “lower,” “left,” “right”) or to describedirection of movement within a particular degree of freedom (e.g.,“leftwards,” “rightwards,” “up,” “down”). This terminology and theillustrated mapping are not intended to limit the invention, and aperson having ordinary skill in the art will appreciate that thesedirectional terms can be mapped to the device or any component thereofin any of a variety of ways.

Components described herein as being coupled may be directly coupled, orthey may be indirectly coupled via one or more intermediate components.

As noted below, the devices disclosed herein can be at least partiallypositioned inside a patient's body cavity through an access point in atissue surface for minimally invasive surgical procedures. Typically,cannulas are used to provide a pathway through a tissue surface and toprevent a surgical device or guide tube from rubbing on patient tissue.Cannulas can be used for both incisions and natural orifices. Somesurgical procedures require insufflation, and the cannula can includeone or more seals to prevent insufflation gas from leaking past thesurgical device or guide tube. In some embodiments, the cannula can havea housing coupled thereto with one or more sealed ports for receivingvarious types of instruments or for receiving a plurality of the devicesdisclosed herein. It will be appreciated by those skilled in the artthat any of the surgical device components disclosed herein can have afunctional seal disposed thereon, therein, and/or therearound to preventand/or reduce insufflation leakage while any portion of the device isdisposed through a surgical access port, such as the cannula notedabove. The surgical devices disclosed herein can also be used in opensurgical procedures. As used herein, a surgical access point is a pointat which the device enters a body cavity through a tissue surface,whether through a cannula in a minimally invasive procedure or throughan incision in an open procedure.

The various components of the devices disclosed herein can be formedfrom any of a variety of materials known in the art and suitable for usein surgical devices. For example, the various components can be formedfrom metal (e.g., stainless steel, titanium), plastic (e.g.,polyetheretherketone (PEEK)), and/or combinations thereof.

Further details regarding surgical devices are disclosed in U.S. patentapplication Ser. No. 12/971,434, entitled “Surgical System and Methodsfor Mimicked Motion,” the entire contents of which are incorporatedherein by reference and in U.S. patent application Ser. No. 12/904,280,entitled “Laparoscopic Device with Distal Handle,” the entire contentsof which are incorporated herein by reference.

Surgical Device Generally

One exemplary embodiment of a surgical device 10 is illustrated in FIGS.2A-2F. The surgical device 10 generally includes a distal wrist assembly100, a distal elbow assembly 200, a body assembly 300, a proximal elbowassembly 400, a proximal wrist assembly 500, and a handle assembly 600.The device 10 can also include a plurality of cables, which for clarityof illustration are not shown in FIGS. 2A-2F.

The device 10 can include a “master” or “input” component (i.e., a pairof handle levers 602A, 602B included in the handle assembly 600) and a“slave” or “output” component (i.e., an end effector assembly 108included in the distal wrist assembly 100). The device 10 can provide amechanical linkage between the master component and the slave componentsuch that movement or actuation of the master component effectscorresponding movement or actuation of the slave component. As explainedbelow, this corresponding movement or actuation can be mirrored,mimicked, or some combination thereof, depending on the configuration ofthe device. In addition, the degree of actuation or movement can bescaled.

In use, as shown in FIG. 2C, the distal wrist assembly 100, the distalelbow assembly 200, and at least a portion of the body assembly 300 canbe inserted through the working channel of a surgical access device,such as a trocar or cannula 12 positioned in an incision 14 formed in apatient 16. The slave component can thus be positioned within a bodycavity 18 of the patient 16, while the master component remains externalto the body cavity 18.

The body assembly 300 of the device can be slidably and rotatablyreceived within a linear bearing 20, the position and orientation ofwhich can be fixed in a desired position within the operative field. Forexample, the linear bearing 20 can be coupled to a frame 22 that isaffixed to a stationary object, such as a hospital bed, an operatingtable, the floor, the ceiling, etc. Although the position andorientation of the linear bearing 20 is fixed, the body assembly 300 isfree to surge (e.g., by sliding along its longitudinal axis L in or outof the linear bearing 20 and the trocar 12) or to roll (e.g., byrotating about its longitudinal axis L relative to the linear bearing 20and the trocar 12). It will be appreciated, however, that the frame andlinear bearing 20 can substantially prevent the body assembly 300 fromswaying, heaving, pitching, and yawing. This restriction dramaticallyreduces interference between plural devices inserted through a singleincision or access device, as the elongate body assemblies of the pluraldevices can be kept substantially parallel or in a fixed angularorientation relative to one another. At the same time, the ability tomove the end effector assemblies of the plural devices with at least sixdegrees of freedom can be preserved. Exemplary single site accessdevices with which the device 10 can be used are disclosed in U.S.Publication No. 2011/0028793, entitled “Methods and Devices forProviding Access into a Body Cavity,” the entire contents of which areincorporated herein by reference.

Once the device 10 is secured to a frame or other fixed reference, theextracorporeal master component can be manipulated by a user to controlmovement and actuation of the intracorporeal slave component.

The end effector assembly 108 can be actuated by squeezing the handlelevers 602A, 602B together to squeeze together the jaws of the endeffector assembly, or by spreading the handle levers apart to spreadapart the jaws of the end effector assembly. The end effector assembly108 can also be moved with at least six degrees of freedom. Surge(in-out translational movement) and roll (longitudinal rotation) of thehandle levers 602A, 602B can be communicated to the end effectorassembly 108 by the body assembly 300. Sway (left-right translationalmovement) and heave (up-down translational movement) of the handlelevers 602A, 602B can be communicated to the end effector assembly 108by the proximal and distal elbow assemblies 200, 400. Pitch (up-downpivoting movement) and yaw (left-right pivoting movement) of the handlelevers 602A, 602B can be communicated to the end effector assembly 108by the proximal and distal wrist assemblies 100, 500.

FIGS. 2D-2F show views of the device 10 in an articulated position fromvarious observation angles. The device is articulated in the exact samemanner in each of FIGS. 2D-2F, the only change being in the positionfrom which the device 10 is observed.

As shown in FIG. 2D, in which the device 10 is viewed from the side,tilting the nose of the handle levers up causes the proximal wristassembly 500 to pivot. This pivoting is transmitted by cable to causethe distal wrist assembly 100 to pivot such that the nose of the endeffector assembly is likewise tilted up, thereby achieving mimickedpitch.

As also shown in FIG. 2D, translating the nose of the handle levers downcauses the proximal elbow assembly 400 to shift. This shifting istransmitted by cable to cause the distal elbow assembly 200 to shiftsuch that the nose of the end effector assembly is likewise translateddown, thereby achieving mimicked heave.

As shown in FIG. 2E, tilting the nose of the handle levers left causesthe proximal wrist assembly 500 to pivot. This pivoting is transmittedby cable to cause the distal wrist assembly 100 to pivot such that thenose of the end effector assembly is likewise tilted left, therebyachieving mimicked yaw.

As also shown in FIG. 2E, translating the nose of the handle leversright causes the proximal elbow assembly 400 to shift. This shifting istransmitted by cable to cause the distal elbow assembly 200 to shiftsuch that the nose of the end effector assembly is likewise translatedright, thereby achieving mimicked sway.

The device 10 can thus permit extracorporeal control of end effectorassembly actuation and end effector assembly movement with at least sixdegrees of freedom. The structure and operation of the device 10 isdescribed in detail below.

Distal Wrist Assembly

The distal wrist assembly 100 can provide a first pivot joint foraltering the pitch of the end effector assembly (e.g., for pivoting theend effector assembly in the “up-down” direction) and a second pivotjoint for altering the yaw of the end effector assembly (e.g., forpivoting the end effector assembly in the “left-right” direction). Thedistal wrist assembly 100 can also include the end effector assembly anda plurality of pulleys for receiving the various cables that impartpitch (up-down pivot) or yaw (left-right pivot) motion to the endeffector assembly.

As shown in FIGS. 3A-3D, the distal wrist assembly 100 can include firstand second wrist frames 102, 104, a plurality of guide pulleys 106A,106B, 106C, 106D, and an end effector assembly 108. In the illustratedembodiment, the end effector assembly 108 includes first and secondmajor jaws 110A, 110B and first and second minor jaws 112A, 112B,however any of a variety of end effectors can be used without departingfrom the scope of the present invention. For clarity of illustration,the cables used to control movement of the distal wrist assembly 100 arenot shown in FIGS. 3A-3D, however these cables are illustrated anddescribed in detail below.

The first wrist frame 102 can include a cylindrical body portion 114that defines a central passageway 116 through which the control cablescan be routed. A clevis 118 extending distally from the cylindrical bodyportion 114 can be defined by a pair of opposed prongs 120, each pronghaving a through hole 122 formed therein for receiving a pitch (up-down)pivot pin 124.

The second wrist frame 104 can include a double clevis, the proximalclevis 126 being oriented perpendicular to the distal clevis 128. Theproximal clevis 126 can include opposed prongs 130A, 130B having throughholes 132A, 132B formed therein for receiving the pitch pivot pin 124such that the second wrist frame 104 is rotatable about the pitch pivotpin 124. It will be appreciated that the pitch pivot pin 124 can befixed with respect to one of the first wrist frame 102 and the secondwrist frame 104, or can be rotatable relative to both the first wristframe 102 and the second wrist frame 104. Each prong 130A, 130B of theproximal clevis 126 can also include an integral pulley 134A, 134B forreceiving and/or seating a control cable. The proximal clevis 126 can besized to be received within the clevis 118 of the first wrist frame 102such that the first wrist frame 102, second wrist frame 104, and pitchpivot pin 124 form a pivot joint about which the end effector assembly108 can be pivoted in the up-down direction (e.g., about which the endeffector assembly 108 can pitch). The pitch pivot pin 124 can also serveas an axle for the guide pulleys 106A, 106B, 106C, 106D which areindividually rotatable relative to the pitch pivot pin 124.

The distal clevis 128 of the second wrist frame 104 can include opposedprongs 136A, 136B having through holes 138A, 138B formed therein forreceiving a yaw (left-right) pivot pin 140. The opposed prongs 136A,136B can be spaced a distance apart from one another such that the endeffector assembly 108, and in particular the cylindrical portions 142A,142B, 142C of the first and second major jaws 110A, 110B, can berotatably received therebetween, as described below.

The first major jaw 110A can include a proximal cylindrical portion 142Aand an elongate distal tip 144A. The proximal cylindrical portion 142Acan have a through hole 146A formed therein for receiving the yaw pivotpin 140, and can have upper and lower cable tracks 148A, 150A formedtherein such that the proximal cylindrical portion 142A can act as acable pulley. The distal tip 144A can have a gripping surface 152A witha plurality of surface features formed thereon to facilitate gripping orgrasping of various objects with the device 10, such as needles,sutures, or tissue. A cavity or recess 154A can be formed in thegripping surface 152A for receiving the first minor jaw 112A. A throughhole 156A can be formed in the distal tip 144A intersecting with thecavity 154A for receiving a first minor jaw pivot pin 158A about whichthe first minor jaw 112A rotates.

The second major jaw 110B can include upper and lower proximalcylindrical portions 142B, 142C and an elongate distal tip 144B. Theupper and lower proximal cylindrical portions 142B, 142C can havethrough holes 146B, 146C formed therein for receiving the yaw pivot pin140 and can be spaced apart from one another such that the proximalcylindrical portion 142A of the first major jaw 110A can be receivedtherebetween. The upper and lower proximal cylindrical portions 142B,142C can also have respective cable tracks 148B, 150B formed thereinsuch that they can act as cable pulleys. The distal tip 144B can have agripping surface 152B with a plurality of surface features formedthereon which can be sized and positioned to interlock with and engagethe surface features formed on the first major jaw 110A. A cavity orrecess 154B can be formed in the gripping surface 152B for receiving thesecond minor jaw 112B. A through hole 156B can be formed in the distaltip 144B intersecting with the cavity 154B for receiving a second minorjaw pivot pin 158B about which the second minor jaw 112B rotates.

The second wrist frame 104, the first and second major jaws 110A, 11B,and the yaw pivot pin 140 can collectively form a pivot joint aboutwhich the end effector assembly 108 can yaw (i.e., pivot in theleft-right direction). When the first and second major jaws 110A, 110Bare pivoted about the yaw pivot pin 140 simultaneously in the samedirection, left-right pivot motion or yaw of the end effector assembly108 can be achieved. If only one of the jaws 110A, 110B is pivoted aboutthe yaw pivot pin 140, or if the jaws 110A, 110B are pivoted in oppositedirections, actuation of the end effector assembly 108 (e.g. opening orclosing of the jaws) can be achieved.

The first and second major jaws 110A, 110B can be actuated using one ormore cables, as described in detail below. One concern associated withcable-based systems is that an increase in cable tension is generallyrequired to achieve an increase in closing or gripping force at the endeffector. The increased tension on the cables increases friction betweenthe cables and the various pulleys about which they are wrapped,dramatically increasing the input force required to manipulate thedevice and reducing the overall smoothness of operation. In theillustrated embodiment, this issue is addressed by the first and secondminor jaws 112A, 112B of the end effector assembly 108.

The first and second minor jaws 112A, 112B can each include a proximalcylindrical portion 160A, 160B and a distal tip portion 162A, 162Bhaving a gripping surface formed thereon. The proximal cylindricalportions 160A, 160B of the jaws 112A, 112B can be rotatably coupled toeach other, for example using a ball and socket joint, cylinder and cupjoint, pivot pin, or other coupling. In addition, the distal tips 162A,162B of the jaws 112A, 112B can be rotatably coupled to the first andsecond major jaws 110A, 110B via the first and second minor jaw pivotpins 158A, 158B, respectively. In operation, as the major jaws 110A,110B approach one another, moving towards a closed position, the minorjaws 112A, 112B likewise approach one another, while simultaneouslybeing received within the corresponding cavities 154A, 154B formed inthe major jaws 110A, 110B.

The minor jaws 112A, 112B can be shorter than the major jaws 110A, 110Band therefore can provide a mechanical advantage which amplifies theclosing force without requiring a corresponding increase in cabletension. The length of the minor jaws 112A, 112B and the point at whichthey are coupled to the major jaws 110A, 110B can be varied to obtainthe desired amplification factor. In the illustrated embodiment, theproximal ends of the minor jaws 112A, 112B are positioned distal to theproximal ends of the major jaws 110A, 110B and the distal ends of theminor jaws 112A, 112B are positioned adjacent to or just proximal to thedistal ends of the major jaws 110A, 110B. The ratio of the length of themajor jaws 110A, 110B to the length of the minor jaws 112A, 112B can beabout 2:1, as shown, or can be any of a variety of other ratios, such as3:1, 4:1, 5:1, 10:1, etc.

Distal Elbow Assembly

The distal elbow assembly 200 can provide for 360 degree translationalmovement of the distal wrist assembly 100 (and thus the end effectorassembly 108) relative to the body assembly 300.

As shown in FIGS. 4A-4D, the distal elbow assembly 200 can includeproximal and distal retainer housings 202 p, 202 d, proximal and distalretainer inserts 204 p, 204 d, proximal and distal elbow plates 206 p,206 d coupled to one another by a torque tube 208, and a plurality ofcone rods 210A, 210B, 210C. For clarity of illustration, the cables usedto control movement of the distal elbow assembly 200 are not shown inFIGS. 4A-4D, nor are the cables used to control movement of the distalwrist assembly 100, which cables extend through the distal elbowassembly 200. These cables are illustrated and described in detailbelow.

The proximal and distal retainer housings 202 p, 202 d can includecylindrical bodies having passageways 212 p, 212 d formed therethroughfor receiving the cables used to impart motion to the distal wristassembly 100. A reduced diameter portion 214 d of the distal retainerhousing 202 d can be sized to be received within the proximal end of thefirst wrist frame 102, so as to couple the distal wrist assembly 100 tothe distal elbow assembly 200. A reduced diameter portion 214 p of theproximal retainer housing 202 p can be sized to be received within adistal opening 304 of the body assembly 300, so as to couple the distalelbow assembly 200 to the body assembly 300. The proximal and distalretainer housings 202 p, 202 d can be coupled to the distal wristassembly 100 and the body assembly 300, respectively, using any of avariety of techniques, such as a friction fit, weld joint, adhesives,screws, pins, rivets, and so forth. In addition, tension applied to thecables extending through the device 10 can augment the mating betweenthe various assemblies thereof.

An enlarged diameter portion 216 p of the proximal retainer housing 202p can be sized to receive the proximal retainer insert 204 p. The innercircumference of the enlarged diameter portion 216 p can include threeprotrusions 218 p spaced evenly 120 degrees apart from one another. Aconcavity 220 p can be formed in the distal-facing surface of each ofthe protrusions 218 p for receiving the proximal conical tip 230 p of acorresponding cone rod 210.

The proximal retainer insert 204 p can include a cylindrical body havingthree cutouts 222 p formed therein. The three cutouts 222 p can bespaced evenly 120 degrees apart from one another about the circumferenceof the proximal retainer insert 204 p and can be sized to receive thethree protrusions 218 p formed in the proximal retainer housing 202 p.The proximal retainer insert 204 p can also include a plurality ofthrough holes 224 p which can serve as a guide channel for the variouscables extending through the device 10. The through holes 224 p canoptionally be coated or lined with a friction reducing material tofacilitate sliding of the cables therethrough. It will be appreciatedthat although the proximal retainer housing 202 p and proximal retainerinsert 204 p are shown as separate components, they can also beintegrally formed with each other.

For the sake of brevity, a detailed description of the construction andfunction of the distal retainer housing 202 d and insert 204 d isomitted, it being understood that the distal retainer housing 202 d andinsert 204 d are essentially identical to the proximal retainer housing202 p and insert 204 d, except that they are flipped 180 degrees.

The proximal and distal elbow plates 206 p, 206 d can be coupled to oneanother via the torque tube 208, which can be mated to the center of theelbow plates 206 p, 206 d. The torque tube 208 can be fixedly coupled orformed integrally with the proximal and distal elbow plates 206 p, 206 dsuch that rotational movement of the elbow plates relative to oneanother about the longitudinal axis of the torque tube 208 is prevented.The proximal and distal elbow plates 206 p, 206 d can be disk shapedbodies having a variety of openings formed therein. Three oval-shapedrod passages 226 can be formed in the elbow plates, through which thecone rods 210 can be slidably received. The three rod passages 226 canbe spaced equally 120 degrees apart from one another about thecircumference of the elbow plates 206 p, 206 d. The size and oval shapeof the passages 226 can permit the cone rods 210 to angle slightlyradially towards and away from the center of the elbow plate, but canprevent the rods 210 from angling tangentially relative to the elbowplate. This allows for translational movement of the distal retainerhousing 202 d relative to the proximal retainer housing 202 p, whilepreventing rotation of the distal retainer housing 202 d relative to theproximal retainer housing 202 p about the longitudinal axis of thetorque tube 208. In other words, the elbow plates 206 p, 206 d andtorque tube 208 can prevent the distal elbow assembly 200 from twistingabout the longitudinal axis of the torque tube 208.

The elbow plates 206 p, 206 d can also include a number of through holes228 to allow passage of the various cables extending through the device10.

The cone rods 210 can be substantially rigid, elongate, cylindricalbodies having conical tips 230 p, 230 d formed at the proximal anddistal ends thereof. Each cone rod 210 can extend from the distalretainer housing 202 d, where its distal tip 230 d can be seated withina corresponding concavity 220 d, through the proximal and distal elbowplates 206 p, 206 d, and into the proximal retainer housing 202 p, whereits proximal tip 230 p can be seated within a corresponding concavity220 p. The cone rods 210 can be formed with conical tips to reducefriction as the rods are angled within the concavities 220 p, 220 d. Thecone rods 210 can be free to slide relative to the proximal and distalelbow plates 206 p, 206 d, which serve to maintain a substantiallyparallel relationship between all three cone rods 210A, 210B, 210C atall times, regardless of how the distal elbow assembly 200 ismanipulated. As described in further detail below, cables extendingthrough the device 10 can be coupled at various points to the proximalelbow plate 206 p. When tension is applied to one or more of the cables(i.e., when one or more of the cables are pulled), the proximal elbowplate 206 p moves laterally and is angled relative to the proximalretainer housing 202 p, causing the cone rods 210 to tilt in the samedirection relative to the proximal retainer housing 202 p. As a result,the distal retainer housing 202 d, as well as the distal wrist assembly100 and end effector assembly 108 coupled thereto, are translatedrelative to the proximal retainer housing 202 p.

The cone rods 210 can be substantially the same length and can beretained under compression within the concavities 220 p, 220 d formed inthe proximal and distal retainer housings 202 p, 202 d by tensionapplied to the cables extending through the device 10. As shown in FIGS.4C and 4D, an anchor cable 203 can extend through the distal retainerhousing 202 d, the torque tube 208, and the proximal retainer housing202 p. First and second clips 205 can be crimped onto the ends of theanchor cable 203, adjacent to the proximal and distal retainer housings202 p, 202 d. In addition, a center point 207 of the torque tube 208 canbe crimped down around the anchor cable 203. The anchor cable 203 canthus be effective to maintain the torque tube 208 and the elbow plates206 p, 206 d mounted thereto in a substantially fixed longitudinalposition within the distal elbow assembly 200 (e.g., approximatelycentered between the proximal and distal retainer housings 202 p, 202 din the longitudinal direction).

Body Assembly

The body assembly 300 couples the proximal and distal elbow assemblies200, 400 to one another and houses the various cables used to controlmovement and actuation of the device 10. The length of the body assembly300 can vary depending on any of a variety of parameters, such assurgeon preference, patient size, and location within a patient of asurgery to be performed. The diameter of the body assembly 300 can beselected to correspond to the diameter of a working channel in which thedevice 10 is to be used.

As shown in FIG. 5, the body assembly 300 can include an elongatetubular outer housing 302. The outer housing 302 of the body assembly300 can include a distal opening 304 sized to receive the reduceddiameter portion 214 p of the proximal retainer housing 202 p of thedistal elbow assembly 200. The outer housing 302 can also include aproximal end 306 sized to be received within a distal cavity 414 dformed in the distal retainer housing 402 d of the proximal elbowassembly 400, as explained below.

The outer housing 302 of the body assembly 300 can be sized to beslidably and rotatably received within a central lumen of the linearbearing 20. In one embodiment, the linear bearing 20 includes a hollowtube having a plurality of ball bearings or other friction reducingfeatures lining an interior surface thereof, such that the body assembly300 can slide longitudinally within the linear bearing (surge) androtate longitudinally within the linear bearing (roll).

Proximal Elbow Assembly

The proximal elbow assembly 400 is the “master” counterpart to the“slave” distal elbow assembly 200. Movement of the proximal elbowassembly 400 can be mirrored by the distal elbow assembly 200 such thattranslational movement (e.g., heave and sway) of components proximal tothe proximal elbow assembly 400 can be mimicked by components distal tothe distal elbow assembly 200.

As shown in FIGS. 6A-6D, the proximal elbow assembly 400 can includeproximal and distal retainer housings 402 p, 404 d, proximal and distalretainer inserts 404 p, 404 d, proximal and distal elbow plates 406 p,406 d coupled to one another by a torque tube 408, a plurality of conerods 410A, 410B, 410C, and a cable tension plate 432. For clarity ofillustration, the cables used to control movement of the distal wristassembly 100, which cables extend through the proximal elbow assembly400, are not shown in FIGS. 6A-6D. The cables that control movement ofthe distal elbow assembly 200 are also not shown in FIGS. 6A-6D. Thesecables are illustrated and described in detail below.

The construction and function of the proximal elbow assembly 400 isessentially identical to that of the distal elbow assembly 200, with theexceptions noted herein and shown in the drawings.

The proximal and distal retainer housings 402 p, 402 d can includecylindrical bodies having a plurality of passageways 412 p, 412 d formedtherethrough for receiving the cables used to impart motion to thedistal wrist assembly 100. The distal retainer housing 402 d can alsoinclude passageways for receiving the cables used to impart motion tothe distal elbow assembly 200. A cavity 414 d sized to receive theproximal end 306 of the body assembly 300 can be formed in the distalretainer housing 402 d, and can thus form a female coupling forengagement with the body assembly 300. A reduced diameter portion 414 pof the proximal retainer housing 402 p can be sized to be receivedwithin the distal end of the proximal wrist assembly 500, and can thusprovide a male coupling for engagement with the proximal wrist assembly500. The proximal and distal retainer housings 402 p, 402 d can becoupled to the proximal wrist assembly 500 and the body assembly 300,respectively, using any of a variety of techniques, such as a frictionfit, weld joint, adhesives, screws, pins, rivets, and so forth. Inaddition, tension applied to the cables extending through the device 10can augment the mating between the various assemblies thereof.

An enlarged diameter portion 416 p of the proximal retainer housing caninclude a recess 418 p that is sized to receive the proximal retainerinsert 404 p. The distal facing surface of the proximal retainer housing402 p can include three concavities 420 p positioned around theperiphery of the recess 418 p. The three concavities 420 p can be spacedevenly 120 degrees apart from one another about the circumference of theretainer housing 402 p, and can be sized to receive the proximal conicaltips 430 p of corresponding cone rods 410.

The proximal retainer insert 404 p can include a rectangular body havinga shape that mirrors the recess 418 p of the proximal retainer housing402 p, such that the retainer insert 404 p can be positioned within theretainer housing 402 p. The proximal retainer insert 404 p can alsoinclude a plurality of through holes 424 p which can serve as a guidechannel for the various cables extending through the device 10. Thethrough holes 424 p can optionally be coated or lined with a frictionreducing material to facilitate sliding of the cables therethrough. Itwill be appreciated that although the proximal retainer housing 402 pand the proximal retainer insert 404 p are shown as separate components,they can also be integrally formed with each other.

The distal retainer housing 402 d and insert 404 d are substantiallyidentical to the proximal retainer housing 402 p and insert 404 p,except that they are flipped 180 degrees in the proximal-distaldirection. In addition, as described above, the proximal retainerhousing 402 p can include a male coupling whereas the distal retainerhousing 402 d can provide a female coupling.

The proximal and distal elbow plates 408 p, 408 d can be coupled to oneanother via the torque tube 408, which can be mated to the center of theelbow plates. The torque tube 408 can be fixedly coupled or formedintegrally with the proximal and distal elbow plates 408 p, 408 d suchthat rotational movement of the elbow plates relative to one anotherabout the longitudinal axis of the torque tube 408 is prevented. Theproximal and distal elbow plates 408 p, 408 d can be disk shaped bodieshaving a variety of openings formed therein. Three oval-shaped rodpassages 426 can be formed in the elbow plates, through which the conerods 410 can be slidably received. The three rod passages 426 can bespaced equally 120 degrees apart from one another about thecircumference of the elbow plates. The size and oval shape of thepassages 426 can permit the cone rods 410 to angle slightly radiallytowards and away from the center of the elbow plate, but prevent therods from angling tangentially relative to the elbow plate. This allowsfor translational movement of the distal retainer housing 402 d relativeto the proximal retainer housing 402 p, while preventing rotation of thedistal retainer housing 402 d relative to the proximal retainer housing402 p about the longitudinal axis of the torque tube 408. In otherwords, the elbow plates 406 p, 406 d and torque tube 408 can prevent theproximal elbow assembly 400 from twisting about the longitudinal axis ofthe torque tube 408.

The elbow plates 406 p, 406 d can also include a number of through holes428 to allow passage of the various cables extending through the device10.

The cone rods 410 can be substantially rigid, elongate, cylindricalbodies having conical tips 430 p, 430 d formed at the proximal anddistal ends thereof. Each cone rod 410 can extend from the distalretainer housing 402 d, where its distal tip 430 d can be seated withina corresponding concavity 420 d, through the proximal and distal elbowplates 406 p, 406 d, and into the proximal retainer housing 402 p, whereits proximal tip 430 p can be seated within a corresponding concavity420 p. The cone rods 410 can be formed with conical tips to reducefriction as the rods are angled within the concavities 420 p, 420 d. Thecone rods 410 can be free to slide relative to the proximal and distalelbow plates 406 p, 406 d, which serve to maintain a substantiallyparallel relationship between all three cone rods 410A, 410B, 410C atall times, regardless of how the proximal elbow assembly 400 ismanipulated. The cone rods 410 can be substantially the same length andcan be retained under compression within the concavities 420 p, 420 dformed in the proximal and distal retainer housings 402 p, 402 d bytension applied to the cables extending through the device 10.

The proximal elbow assembly 400 can also includes a cable tension plate432. The tension plate 432 can be similar in construction to theproximal and distal elbow plates 406 p, 406 d, in that it can besubstantially disk-shaped, rigidly coupled to the torque tube 408, andcan include a plurality of oval-shaped rod passages 426 for receivingthe cone rods 410 and a plurality of round through holes 428 forreceiving the cables used to impart motion to the distal wrist assembly100. As described in further detail below, cables extending through thedevice 10 can be coupled at various points to the cable tension plate432. In particular, three cables used to control the distal elbowassembly 200 can be coupled to three tension screws 434A, 434B, 434C,which are threadably coupled to the tension plate 432. Accordingly, thetension of any one of the three cables can be adjusted by turning itscorresponding tension screw 434.

When the proximal retainer housing 402 p moves laterally relative to thedistal retainer housing 402 d, the cone rods 410 tilt, causing thetension plate 432 to also move laterally and be angled relative to thedistal retainer housing 402 d. This results in tension being applied toone or more of the cables extending from the tension plate 432 whiletension is simultaneously removed from one or more of the cables. Inother words, one or more cables are pulled while one or more othercables are released. This pulling and releasing effects a lateralmovement and angling of the proximal elbow plate 206 p of the distalelbow assembly 200 relative to the proximal retainer housing 202 p ofthe distal elbow assembly 200. Lateral motion of the proximal elbowassembly 400 is thus mirrored by lateral motion of the distal elbowassembly 200. This motion relationship is discussed in further detailbelow. As shown in FIGS. 6C and 6D, an anchor cable 403 can extendthrough the distal retainer housing 402 d, the torque tube 408, and theproximal retainer housing 402 p. First and second clips 405 can becrimped onto the ends of the anchor cable 403, adjacent to the proximaland distal retainer housings 402 p, 402 d. In addition, a center point407 of the torque tube 408 can be crimped down around the anchor cable403. The anchor cable 403 can thus be effective to maintain the torquetube 408 and the elbow plates 406 p, 406 d mounted thereto in asubstantially fixed longitudinal position within the proximal elbowassembly 400 (e.g., approximately centered between the proximal anddistal retainer housings 402 p, 402 d in the longitudinal direction).

Proximal Wrist Assembly

The proximal wrist assembly 500 is the “master” counterpart to the“slave” distal wrist assembly 100. The proximal wrist assembly 500 canprovide a first pivot joint for pivoting the handle assembly 600 in theup-down direction (i.e., changing the pitch of the handle assembly 600)and a second pivot joint for pivoting the handle assembly 600 in theleft-right direction (i.e. changing the yaw of the handle assembly 600).The proximal wrist assembly 500 can also include a plurality of pulleysfor receiving the various cables that impart pitch (up-down) or yaw(left-right) pivot motion to the end effector assembly 108. Movement ofthe proximal wrist assembly 500 is mimicked by the distal wrist assembly100 such that pivoting movement of components proximal to the proximalwrist assembly 500 is mimicked by components distal to the distal wristassembly 100. This movement relationship is discussed in further detailbelow.

As shown in FIGS. 7A-7D, the proximal wrist assembly 500 can include adistal wrist frame 502, a central wrist frame 504, and a proximal wristframe 506. The proximal wrist assembly 500 can also include a centralpulley system 508 and a proximal pulley system 510, as well as first andsecond tension screws 512A, 512B. For clarity of illustration, thecables used to control movement of the distal wrist assembly 100, whichcables extend through the proximal wrist assembly 500, are not shown inFIGS. 7A-7D. These cables are illustrated and described in detail below.

The distal wrist frame 502 can include a cylindrical body portion 514that defines a central passageway 516 through which the control cablescan be routed. The cylindrical body portion 514 can taper conically to adistal female receptacle 518, which can be sized to receive the reduceddiameter proximal portion 414 p of the proximal retainer housing 402 pof the proximal elbow assembly 400. The proximal elbow assembly 400 canthus be coupled to the proximal wrist assembly 500. First and secondtensions screws 512A, 512B are threadably received in the distal wristframe 502, and can be rotated to adjust the tension applied to cablescoupled thereto, as described further below.

A clevis 520 extending proximally from the cylindrical body portion 514can be defined by a pair of opposed prongs 522 each prong having athrough hole 524 formed therein for receiving a yaw (left-right) pivotpin 526.

The central wrist frame 504 can include a double clevis, the distalclevis 528 d being oriented perpendicular to the proximal clevis 528 p.The distal clevis 528 d can include opposed prongs 530 having throughholes 532 formed therein for receiving the yaw pivot pin 526 such thatthe central wrist frame 504 is rotatable about the yaw pivot pin 526relative to the distal wrist frame 502. It will be appreciated that oneof the central wrist frame 504 and the distal wrist frame 502 can befixed to the yaw pivot pin 524, or that both the central wrist frame 504and the distal wrist frame 502 can rotate relative to the yaw pivot pin524. The distal clevis 528 d can also include two pairs of through holes534-1, 534-2 for receiving first and second vertical pulley axles 536-1,536-2. The distal clevis 528 d of the central wrist frame 504 can besized to be received within the clevis 520 of the distal wrist frame 502such that the distal wrist frame 502, central wrist frame 504, and yawpivot pin 526 form a pivot joint about which the handle assembly 600 canbe pivoted in the left-right direction (i.e., about which the yaw of thehandle assembly 600 can be adjusted). The yaw pivot pin 526 can alsoserve as an axle for a plurality of pulleys, as detailed below.

The proximal clevis 528 p of the central wrist frame 504 can includeopposed prongs 538 having through holes 540 formed therein for receivinga pitch (up-down) pivot pin 542. The opposed prongs 538 can be sized tobe received between opposed prongs 544 of a clevis 546 formed at thedistal end of the proximal wrist frame 506. The opposed prongs 544 canalso have through holes 548 formed therein for receiving the pitch pivotpin 542, such that the central wrist frame 504 is rotatable about thepitch pivot pin 542 relative to the proximal wrist frame 506. It will beappreciated that one of the central wrist frame 504 and the proximalwrist frame 506 can be fixed to the pitch pivot pin 542, or that boththe central wrist frame 504 and the proximal wrist frame 506 can rotaterelative to the pitch pivot pin 542. The proximal clevis 528 p can alsoinclude two pairs of through holes 550-1, 550-2 for receiving first andsecond horizontal pulley axles 552-1, 552-2. Collectively, the proximalwrist frame 506, central wrist frame 504, and pitch pivot pin 542 form apivot joint about which the handle assembly 600 can be pivoted in theup-down direction (i.e., about which the pitch of the handle assembly600 can be adjusted). The pitch pivot pin 542 can also serve as an axlefor a plurality of pulleys, as detailed below.

The proximal wrist frame 506 can include a generally rectangular body554 having the clevis 546 described above extending distally therefrom.The proximal wrist frame 506 can also include a tubular femalereceptacle 556 at its proximal end for receiving the center link 632 ofthe handle assembly 600, as described below. First and second throughholes 558-1, 558-2 can also be provided in the proximal wrist frame 506,adjacent to the tubular female receptacle 556, which each can receive arespective handle lever pivot pin 628A, 628B.

The proximal wrist frame 506 can also include seven through holes thatreceive seven corresponding idler pulley assemblies 560-1 through 560-7.Five of the idler pulley assemblies (560-3 through 560-7) can bereceived in through holes are formed in a main portion 562 of theproximal wrist frame 506. The other two idler pulley assemblies 560-1,560-2 can be received in through holes formed in a recessed ledgeportion 564 of the proximal wrist frame 506.

FIG. 8 illustrates the central pulley system 508 of the proximal wristassembly 500 in more detail. As shown, the first vertical pulley axle536-1 can include two idler pulleys 536-1A, 536-1B mounted thereon andcan be mounted in through holes 534-1 formed in the central wrist frame504. The second vertical pulley axle 536-2 can also include two idlerpulleys 536-2A, 536-2B mounted thereon and can be mounted in throughholes 534-2 formed in the central wrist frame 504. The yaw pivot pin 526can include four major pulleys 566A, 566B, 566C, 566D and four minorpulleys 568A, 568B, 568C, 568D. The yaw pivot pin 526 can be mounted inthrough holes 532 formed in the central wrist frame 504.

As also shown in FIG. 8, the first horizontal pulley axle 552-1 caninclude two idler pulleys 552-1A, 552-1B mounted thereon and can bemounted in through holes 550-1 formed in the central wrist frame 504.The second horizontal pulley axle 552-2 can also include two idlerpulleys 552-2A, 552-2B mounted thereon and can be mounted in throughholes 550-2 formed in the central wrist frame 504. The pitch pivot pin542 can include four major pulleys 570A, 570B, 570C, 570D and four minorpulleys 572A, 572B, 572C, 572D mounted thereon and can be mounted inthrough holes 540 formed in the central wrist frame 504.

The pulleys of the central pulley system are shown in more detail inFIGS. 9A-9B. As shown, the pulleys can be generally cylindrical and canhave a through hole formed along their central rotational axis R forreceiving a pulley axle. The pulleys can be individually rotatablerelative to their respective axles. Each pulley can have first andsecond V-shaped grooves or cable tracks 574A, 574B formed about thecircumferential sidewall of the pulley. A pair of exterior retainerwalls 576A, 576B can be positioned above and below the cable tracks574A, 574B to prevent cables from slipping off of the pulley. Thedividing wall 578 between the cable tracks can be rounded such that asingle cable can be wound partially around the pulley in one track andthen partially around the pulley in the other track. In other words, thecable can wrap onto the pulley in a first track, wrap partially aroundthe pulley, cross over into the adjacent track, and then come back offof the pulley, such that the cable wraps 360 degrees around the pulley,approximately 180 degrees in the first track and approximately 180degrees in the second track. It will be appreciated that the extent towhich the cable wraps around the pulley is dictated in part by thedegree to which the device 10 is articulated. In one embodiment, thecables are wrapped approximately 360 degrees around the pulleys when thedevice 10 is in a straight, non-articulated configuration. As the device10 is articulated, more or less of the cable can be wrapped around thepulley. For example, in one embodiment, when the device 10 is fullyarticulated in a first direction, the cable can be wrapped 225 degreesaround the pulley and when the device 10 is fully articulated in theopposite direction, the cable can be wrapped 495 degrees around thepulley.

This “double-winding” of cables around the pulleys provides a number ofadvantages. For example, the double-winding can help maintain enoughcontact radius between the cable and the pulley to keep the cable seatedin the pulley when the pulley is moved during device manipulation. Ifnot double-wound, the pulley systems of the device would require manymore passive idler pulleys to keep the cables in their tracks.Otherwise, loss of contact radius between cable and pulley when thedevice is articulated could cause a cable to slip off of the pulley. Bydouble-winding the cables, they can be prevented from slipping off ofthe pulleys without requiring the addition of several additional idlerpulleys. This reduces the overall complexity of the device, and permitsthe pitch pivot pin 542 to be placed in very close proximity to the yawpivot pin 526, minimizing wobble error. Wobble error is the deviationfrom a perfect spherical composite range of motion introduced when thepitch axis is offset from the yaw axis. Minimizing this offset reducesthe wobble error and produces a tighter correspondence between masterand slave motion.

As shown in FIG. 9B, the major pulleys can have a diameter D1 that isapproximately twice the diameter D2 of the minor pulleys. This diameterratio permits cables to be wound through the central pulley system 508twice for tension compensation without skewing movement of the endeffector assembly 108. This concept is described in further detailbelow. The guide pulleys 106A, 106B, 106C, 106D of the distal wristassembly 100 (shown in FIGS. 3A-3D) can be substantially identical tothe major pulleys shown in FIG. 9B, both in structure and dimension.

FIGS. 10A-10C illustrate the proximal pulley system 510 of the proximalwrist assembly 500 in more detail. As shown, the proximal pulley system510 can be mounted to the proximal wrist frame 506 of the proximal wristassembly 500. The proximal pulley system can generally include sevenidler pulley assemblies 560-1 through 560-7, each having one or twoidler pulleys, a pulley axle, and one or more c-clip retainers. FIG. 10Ashows a top view of the proximal wrist frame 506, whereas FIG. 10B showsa bottom view. FIG. 10C is an exploded top view.

The first idler pulley assembly 560-1 extends through a through holeformed in the recessed ledge portion 564 of the proximal wrist frame506. The first idler pulley assembly includes an upper pulley 560-1Uthat sits above the recessed ledge portion 564, and a lower pulley560-1L that sits below the recessed ledge portion 564.

The second idler pulley assembly 560-2 extends through a through holeformed in the recessed ledge portion 564 of the proximal wrist frame506. The second idler pulley assembly includes an upper pulley 560-2Uthat sits above the recessed ledge portion 564, and a lower pulley560-2L that sits below the recessed ledge portion 564.

The third idler pulley assembly 560-3 extends through a through holeformed in the main portion 562 of the proximal wrist frame 506. Thethird idler pulley assembly includes an upper pulley 560-3U that sitsabove the main portion 562, and a lower pulley 560-3L that sits belowthe main portion 562.

The fourth idler pulley assembly 560-4 extends through a through holeformed in the main portion 562 of the proximal wrist frame 506. Thefourth idler pulley assembly includes a lower pulley 560-4L that sitsbelow the main portion 562.

The fifth idler pulley assembly 560-5 extends through a through holeformed in the main portion 562 of the proximal wrist frame 506. Thefifth idler pulley assembly includes an upper pulley 560-5U that sitsabove the main portion 562.

The sixth idler pulley assembly 560-6 extends through a through holeformed in the main portion 562 of the proximal wrist frame 506. Thesixth idler pulley assembly includes a lower pulley 560-6L that sitsbelow the main portion 562.

The seventh idler pulley assembly 560-7 extends through a through holeformed in the main portion 562 of the proximal wrist frame 506. Theseventh idler pulley assembly includes an upper pulley 560-7U that sitsabove the main portion 562.

The height of the pulleys of the first and second idler pulleyassemblies 560-1, 560-2 can be selected such that the pulleys do notextend above the deck of the main portion 562 of the proximal wristframe 506. This prevents interference between cables routed through thefirst and second idler pulley assemblies 560-1, 560-2 and cables routedthrough the third through seventh idler pulley assemblies 560-3 through560-7.

The pulleys of the proximal pulley system 510 are shown in more detailin FIGS. 11A-11B. As shown, the pulleys can be generally cylindrical andcan have a through hole formed along their central rotational axis R forreceiving a pulley axle 580. The pulleys can be individually rotatablerelative to their respective axles. Since the pulleys of the illustratedproximal pulley system 510 are not double-wound, they include only asingle cable track 582. A pair of exterior retainer walls 584 can bepositioned above and below the cable track 582 to prevent cables fromslipping off of the pulley. The pulleys can be slid onto the pulley axle580 and retained by C-shaped retainer clips 586 that engagecorresponding grooves 588 formed in the pulley axle 580.

Handle Assembly

The handle assembly 600 is the “master” counterpart to the “slave” endeffector assembly 108. In other words, movement of the handle assembly600 is mimicked and/or mirrored by the end effector assembly 108. Thismovement relationship is discussed in further detail below.

As shown in FIGS. 12A-12D, the handle assembly 600 can include first andsecond levers 602A, 602B, a biasing linkage assembly 604, a handle lockassembly 606, and a handle pulley system 608. For clarity ofillustration, the cables used to control movement of the distal wristassembly 100, which cables extend around the handle pulley system 608,are not shown in FIGS. 12A-12D. These cables are illustrated anddescribed in detail below.

The first handle lever 602A can include a gripping portion 610A that canbe contoured to provide an ergonomic gripping surface for a user. Thehandle lock assembly 606 can be mounted in a cutout 612A formed in thefirst handle lever 602A, and can include a spring biased locking hook614 that can engage a corresponding cutout 612B formed in the secondhandle lever 602B to lock the handle levers 602A, 602B in a closedposition (e.g., a position in which the handle levers are proximate toone another).

The distal end of the first handle lever 602A can include opposed prongs616A, 618A in which half of the handle pulley system 608 can bereceived. In particular, a hub formed on the upper surface of an upperpulley 620A can be rotatably received within a through hole 622A formedin the upper prong 616A of the first handle lever 602A. Similarly, a hubformed on the lower surface of a lower pulley 624A can be rotatablyreceived within a through hole 626A formed in the lower prong 618A ofthe first handle lever 602A. A handle lever pivot pin 628A can bepositioned between the upper and lower pulleys 620A, 624A, providing arotation axle for the pulleys and maintaining the pulleys in positionspaced apart from one another. The handle lever pivot pin 628A can alsobe received in the through hole 558-1 formed in the proximal wrist frame506 to couple the handle assembly 600 to the proximal wrist assembly500.

The upper prong 616A of the first handle lever 602A can also include aplurality of tension adjustment holes 630A positioned circumferentiallyaround the through hole 622A in which the upper pulley 620A is received.A locking pin (not shown) can be inserted through one of the tensionadjustment holes 630A to lock the rotational orientation of the upperpulley 620A relative to the first handle lever 602A. The tension appliedto a cable attached to the upper pulley 620A can be adjusted dependingon which of the plurality of tension adjustment holes 630A the lockingpin is inserted into. The lower prong 618A of the first handle lever602A and the lower pulley 624A can include a similar tension adjustmentsystem.

The second handle lever 620B can also provide a gripping portion 610Bfor the user, and can include a cutout 612B for receiving the lockinghook 614 as described above. The second half of the handle pulley system608 can be received within the distal end of the second handle lever602B, and is identical in structure and function to the first halfdescribed above with respect to the first handle lever 602A.

The biasing linkage assembly 604 can be positioned between the first andsecond handle levers 602A, 602B, and can function to bias the handlelevers 602A, 602B away from one another (e.g., towards a fully-openedposition). The biasing linkage 604 can include a center link 632 that isslidably received within the tubular female receptacle 556 of theproximal wrist frame 506. The biasing linkage 604 can also include firstand second side links 634, 636 that are pivotally coupled to theproximal end of the center link 632 and to the first and second handlelevers 602A, 602B, respectively. A bias spring 638 can be fixedlycoupled at its distal end to the proximal wrist frame 506 and at itsproximal end to the center link 632. In operation, when the handlelevers 602A, 602B are squeezed towards a closed position, the side links634, 636 pivot in a proximal direction relative to the handle levers,causing the center link 632 to slide proximally within the tubularfemale receptacle 556 and causing the bias spring 638 to stretch. Thepotential energy stored in the stretched spring 638 pulls the centerlink 632 distally when the force is removed from the handle levers 602A,602B, causing the side links 634, 636 to pivot in a distal directionrelative to the handle levers, which in turn causes the handle levers tospread apart towards an open position.

The pulleys of the handle pulley system are shown in more detail inFIGS. 13A-13B. As shown, the pulleys can be generally cylindrical. Araised hub 640 can be formed on one surface of the pulley and can besized to rotate within a corresponding through hole formed in the handlelevers 602A, 602B, as explained above. A receptacle 642 can be formed onthe opposite side of the pulley for receiving a handle pivot pin 628A,628B. Since the pulleys of the proximal pulley system are notdouble-wound in the illustrated embodiment, they include only a singlecable track 644. The cable track can flare outward at one location alongits length to form a cavity 646. The pulley can include a cross cut 648adjacent to the cavity 646 such that the cavity can receive a cabletermination (e.g., a ball or crimp). The cable termination can be smallenough to at least partially fit within the cavity 646, but large enoughso as not to pass into the remainder of the cable track 644.Accordingly, when a cable wound around the pulley is placed undertension, a cable termination attached thereto can be held in a fixedposition along the circumference of the cable track 644. The handlepulleys can also include a plurality of tension adjustment holes 650spaced circumferentially around the hub 640, which can be configured toreceive one or more locking pins as explained above to adjust arotational position of the pulley relative to the handle lever andthereby adjust the tension applied to a cable wound around the pulley.

Cable System Generally

Movement imparted by a user to the “master” components (e.g., the handleassembly 600) at the proximal end of the device 10 is translated intocorresponding movement of the “slave” components (e.g., the end effectorassembly 108) at the distal end of the device using a plurality ofcables. The cables can be logically divided into two groups. A firstgroup of six wrist cables can control up-down pivoting movement (pitch)of the slave components, left-right pivoting movement (yaw) of the slavecomponents, and actuation of the slave components (e.g., opening andclosing of the end effector jaws). A second group of three elbow cablescan control up-down translational movement (heave) of the slavecomponents and left-right translational movement of the slave components(sway).

Wrist Cables and Operation

The six wrist cables can include (1) an “up” cable, (2) a “down” cable,(3) a “left” first jaw cable, (4) a “right” first jaw cable, (5) a“left” second jaw cable, and (6) a “right” second jaw cable. The up anddown wrist cables can extend from the proximal clevis prongs 130A, 130Bof the second wrist frame 104 in the distal wrist assembly 100 andthrough the distal elbow assembly 200, the body assembly 300, theproximal elbow assembly 400, and the proximal wrist assembly 500, wherethey can be terminated. The four left and right wrist cables can extendfrom the first and second major jaws 110A, 110B, through the distalelbow assembly 200, the body assembly 300, the proximal elbow assembly400, and the proximal wrist assembly 500, and into the handle assembly600, where they can be terminated. The paths of each of the six wristcables are described in detail below. For clarity of illustration, anumber of components of the device 10 are not shown in the figures thataccompany this description. For example, in the figures corresponding toeach particular cable, all other cables are not shown.

The first wrist cable 702 (i.e., the “up” cable) is shown in FIGS.14A-14B. As shown in FIG. 14A, the terminal distal end 702 d of thefirst wrist cable 702 is attached to the left prong 130B of the proximalclevis 126 of the second wrist frame 104 of the distal wrist assembly100. The cable 702 is then wrapped over the integral pulley 134B andextends proximally through the retainer inserts 204 d, 204 p of thedistal elbow assembly 200, through the outer housing 302 of the bodyassembly 300, and through the retainer inserts 404 d, 404 p of theproximal elbow assembly 400. As shown in FIG. 14B, the cable then entersthe proximal wrist assembly 500, which is shown from above. The cableenters the central pulley system 508 where it is wrappedcounterclockwise around an upper minor pulley 568B on the yaw pivot pin526 and then counterclockwise around the upper idler pulley 536-2A onthe second vertical pulley axle 536-2. The cable then wraps clockwisearound the left idler pulley 552-1B on the first horizontal pulley axle552-1 and then clockwise around a minor pulley 572D on the pitch pivotpin 542. The cable then 702 extends into the proximal pulley system 510,where it wraps counterclockwise around the upper pulley 560-2U of thesecond pulley assembly 560-2 and then counterclockwise around the upperpulley 560-1U of the first pulley assembly 560-1 before extending backinto the central pulley system 508. The cable 702 then wrapscounterclockwise around a minor pulley 572B on the pitch pivot pin 542,counterclockwise around the right idler pulley 552-1A on the firsthorizontal pulley axle 552-1, and then counterclockwise around the upperminor pulley 536-1A on the first vertical pulley axle 536-1. The cable702 then wraps counterclockwise around the other upper minor pulley 568Aon the yaw pivot pin 526 and extends distally into the proximal wristframe 506, where its proximal terminal end 702 p is fixedly attached tothe upper tension screw 512A.

In operation, when the proximal wrist frame 506 is pivoted downwardsrelative to the central wrist frame 504, the first wrist cable 702 ispulled, which causes the second wrist frame 104 to pivot upwardsrelative to the first wrist frame 102. Thus, when the nose or distal endof the handle assembly 600 is aimed upwards (i.e., by tilting theproximal end of the handle assembly down), the distal end of the endeffector assembly 108 is likewise aimed upwards. In other words, upwardspivoting motion of the master is mimicked by upwards pivoting motion ofthe slave.

The second wrist cable 704 (i.e., the “down” cable) is shown in FIGS.15A-15B. As shown in FIG. 15A, the terminal distal end 704 d of thesecond wrist cable 704 is attached to the right prong 130A of theproximal clevis 126 of the second wrist frame 104 of the distal wristassembly 100. The cable 704 is then wrapped under the integral pulley134A and extends proximally through the retainer inserts 204 d, 204 p ofthe distal elbow assembly 200, through the outer housing 302 of the bodyassembly 300, and through the retainer inserts 404 d, 404 p of theproximal elbow assembly 400. As shown in FIG. 15B, the cable 704 thenenters the proximal wrist assembly 500, which is shown from below. Thecable 704 enters the central pulley system 508 where it is wrappedclockwise around one of the lower minor pulleys 568C on the yaw pivotpin 526 and then clockwise around the lower idler pulley 536-1B on thefirst vertical pulley axle 536-1. The cable 704 then wrapscounterclockwise around the right idler pulley 552-2A on the secondhorizontal pulley axle 552-2 and then counterclockwise around a minorpulley 572A on the pitch pivot pin 542. The cable 704 then extends intothe proximal pulley system 510, where it wraps clockwise around thelower pulley 560-1L of the first pulley axle 560-1 and then clockwisearound the lower pulley 560-2L of the second pulley axle 560-2 beforeextending back into the central pulley system 508. The cable 704 thenwraps counterclockwise around a minor pulley 572C on the pitch pivot pin542, clockwise around the left idler pulley 552-2B on the secondhorizontal pulley axle 552-2, and then clockwise around the lower idlerpulley 536-2B on the second vertical pulley axle 536-2. The cable 704then wraps clockwise around the other lower minor pulley 568D on the yawpivot pin 526 and extends distally into the proximal wrist frame 506,where its proximal terminal end 704 p is fixedly attached to the lowertension screw 512B.

In operation, when the proximal wrist frame 506 is pivoted upwardsrelative to the central wrist frame 504, the second wrist cable 704 ispulled, which causes the second wrist frame 104 to pivot downwardsrelative to the first wrist frame 102. Thus, when the nose or distal endof the handle assembly 600 is aimed downwards (i.e., by tilting theproximal end of the handle assembly up), the distal end of the endeffector assembly 108 is likewise aimed downwards. In other words,downwards pivoting motion of the master is mimicked by downwardspivoting motion of the slave.

The third wrist cable 706 (i.e., the “left” first jaw cable) is shown inFIGS. 16A-16B. As shown in FIG. 16A, the terminal distal end 706 d ofthe third wrist cable 706 is attached to the first major jaw 110A, whereit is wound counterclockwise around the upper cable track 148A of theproximal cylindrical portion 142A. The cable 706 is then wrappedclockwise around a guide pulley 106C in the distal wrist assembly 100before extending proximally through the retainer inserts 204 p, 204 d ofthe distal elbow assembly 200, through the outer housing 302 of the bodyassembly 300, and through the retainer inserts 404 p, 404 d of theproximal elbow assembly 400. As shown in FIG. 16B, the cable 706 thenenters the proximal wrist assembly 500, which is shown from above. Thecable 706 enters the central pulley system 508 where it is wrappedcounterclockwise around one of the upper major pulleys 566B on the yawpivot pin 526 and then clockwise around one of the left major pulleys570D of the pitch pivot pin 542. The cable 706 then extends into theproximal pulley system 510, where it wraps clockwise around the upperpulley 560-7U of the seventh pulley assembly 560-7 and thencounterclockwise around the upper pulley 620A of the first handle lever602A, where its terminal proximal end 706 p is fixedly attached.

In operation, when the central wrist frame 504 is pivoted rightwardsrelative to the distal wrist frame 502, the third wrist cable 706 ispulled, which pulls the first major jaw 110A to the left. Thus, when thenose or distal end of the handle assembly 600 is aimed leftwards (i.e.,by tilting the proximal end of the handle assembly to the right), thedistal end of the first major jaw 110A is likewise aimed leftwards. Inother words, leftwards pivoting motion of the master is mimicked byleftwards pivoting motion of the slave.

The fourth wrist cable 708 (i.e., the “right” first jaw cable) is shownin FIGS. 17A-17B. As shown in FIG. 17A, the terminal distal end 708 d ofthe fourth wrist cable 708 is attached to the first major jaw 110A,where it is wound counterclockwise around the lower cable track 150A ofthe proximal cylindrical portion 142A. The cable 708 is then wrappedcounterclockwise around a guide pulley 106B in the distal wrist assembly100 before extending proximally through the retainer inserts 204 p, 204d of the distal elbow assembly 200, through the outer housing 302 of thebody assembly 300, and through the retainer inserts 404 p, 404 d of theproximal elbow assembly 400. As shown in FIG. 17B, the cable 708 thenenters the proximal wrist assembly 500, which is shown from below. Thecable 708 enters the central pulley system 508 where it is wrappedclockwise around one of the lower major pulleys 566D on the yaw pivotpin 526 and then counterclockwise around one of the right major pulleys570B of the pitch pivot pin 542. The cable 708 then extends into theproximal pulley system 510, where it wraps clockwise around the lowerpulley 560-3L of the third pulley assembly 560-3, then counterclockwisearound the lower pulley 560-6L of the sixth pulley assembly 560-6, andthen finally clockwise around the lower pulley 624A of the first handlelever 602A, where its terminal proximal end 708 p is fixedly attached.

In operation, when the central wrist frame 504 is pivoted leftwardsrelative to the distal wrist frame 502, the fourth wrist cable 708 ispulled, which pulls the first major jaw 110A to the right. Thus, whenthe nose or distal end of the handle assembly 600 is aimed rightwards(i.e., by tilting the proximal end of the handle assembly to the left),the distal end of the first major jaw 110A is likewise aimed rightwards.In other words, rightwards pivoting motion of the master is mimicked byrightwards pivoting motion of the slave.

It will be appreciated that instead of using two discrete cables, thethird and fourth wrist cables 706, 708 can be replaced with a singlecable, in which case the single cable can extend through a single cabletrack in the first major jaw 110A and the approximate midpoint of thesingle cable can be held in a fixed position relative to the first majorjaw. This can be accomplished for example by threading the cable throughan aperture in the cable track and forming crimps or knots in the cablewhich are unable to pass through the aperture. Where a single cable isused, it can be conceptualized as having a first length which acts asthe third wrist cable and a second length which acts as the fourth wristcable, the lengths extending proximally from the point where the cableis attached or fixed to the first major jaw.

The fifth wrist cable 710 (i.e., the “left” second jaw cable) is shownin FIGS. 18A-18B. As shown in FIG. 18A, the terminal distal end 710 d ofthe fifth wrist cable 710 is attached to the second major jaw 110B,where it is wound counterclockwise around the cable track 148B of theupper proximal cylindrical portion 142B. The cable 710 is then wrappedclockwise around a guide pulley 106D in the distal wrist assembly 100before extending proximally through the retainer inserts 204 p, 204 d ofthe distal elbow assembly 200, through the outer housing 302 of the bodyassembly 300, and through the retainer inserts 404 p, 404 d of theproximal elbow assembly 400. As shown in FIG. 18B, the cable 710 thenenters the proximal wrist assembly 500, which is shown from above. Thecable 710 enters the central pulley system 508 where it is wrappedcounterclockwise around one of the upper major pulleys 566A on the yawpivot pin 526 and then clockwise around one of the left major pulleys570C of the pitch pivot pin 542. The cable 710 then extends into theproximal pulley system 510, where it wraps counterclockwise around theupper pulley 560-3U of the third pulley assembly 560-3, then clockwisearound the upper pulley 560-5U of the fifth pulley assembly 560-5, andthen finally counterclockwise around the upper pulley 620B of the secondhandle lever 602B, where its terminal proximal end 710 p is fixedlyattached.

In operation, when the central wrist frame 504 is pivoted rightwardsrelative to the distal wrist frame 502, the fifth wrist cable 710 ispulled, which pulls the second major jaw 110B to the left. Thus, whenthe nose or distal end of the handle assembly 600 is aimed leftwards(i.e., by tilting the proximal end of the handle assembly to the right),the distal end of the second major jaw 110B is likewise aimed leftwards.In other words, leftwards pivoting motion of the master is mimicked byleftwards pivoting motion of the slave.

The sixth wrist cable 712 (i.e., the “right” second jaw cable) is shownin FIGS. 19A-19B. As shown in FIG. 19A, the terminal distal end 712 d ofthe sixth wrist cable 712 is attached to the second major jaw 110B,where it is wound around the cable track 150B of the lower proximalcylindrical portion 142C. The cable 712 is then wrapped counterclockwisearound a guide pulley 106A in the distal wrist assembly 100 beforeextending proximally through the retainer inserts 204 p, 204 d of thedistal elbow assembly 200, through the outer housing 302 of the bodyassembly 300, and through the retainer inserts 404 p, 404 d of theproximal elbow assembly 400. As shown in FIG. 19B, the cable 712 thenenters the proximal wrist assembly 500, which is shown from below. Thecable 712 enters the central pulley system 508 where it is wrappedclockwise around one of the lower major pulleys 566C on the yaw pivotpin 526 and then counterclockwise around one of the right major pulleys570A of the pitch pivot pin 542. The cable 712 then extends into theproximal pulley system 510, where it wraps counterclockwise around thelower pulley 560-4L of the fourth pulley assembly 560-4, and thenclockwise around the lower pulley 624B of the second handle lever 602B,where its terminal proximal end 712 p is fixedly attached.

In operation, when the central wrist frame 504 is pivoted leftwardsrelative to the distal wrist frame 502, the sixth wrist cable 712 ispulled, which pulls the second major jaw 110B to the right. Thus, whenthe nose or distal end of the handle assembly 600 is aimed rightwards(i.e., by tilting the proximal end of the handle assembly to the left),the distal end of the second major jaw 110B is likewise aimedrightwards. In other words, rightwards pivoting motion of the master ismimicked by rightwards pivoting motion of the slave.

It will be appreciated that instead of using two discrete cables, thefifth and sixth wrist cables 710, 712 can be replaced with a singlecable, in which case the single cable can extend through a single cabletrack in the second major jaw 110B and the approximate midpoint of thesingle cable can be held in a fixed position relative to the secondmajor jaw. This can be accomplished for example by threading the cablethrough an aperture in the cable track and forming crimps or knots inthe cable which are unable to pass through the aperture. Where a singlecable is used, it can be conceptualized as having a first length whichacts as the fifth wrist cable and a second length which acts as thesixth wrist cable, the lengths extending proximally from the point wherethe cable is attached or fixed to the second major jaw.

FIGS. 20A-20B shows the various pulley systems of the device 10 with allsix wrist cables visible.

In addition to controlling left and right pivoting motion of the endeffector assembly 108, the third wrist cable 706, fourth wrist cable708, fifth wrist cable 710, and sixth wrist cable 712 can also controlactuation of the end effector assembly (e.g., opening and closing of thefirst and second major jaws 110A, 110B).

When the first and second handle levers 602A, 602B are squeezed towardsone another, the third wrist cable 706 is wrapped further onto the upperpulley 620A of the first handle lever 602A, and the sixth wrist cable712 is wrapped further onto the lower pulley 624B of the second handlelever 602B. At the same time, the fourth wrist cable 708 is partiallyunwrapped from the lower pulley 624A of the first handle lever 602A, andthe fifth wrist cable 710 is partially unwrapped from the upper pulley620B of the second handle lever 602B. In other words, the third andsixth wrist cables 706, 712 are pulled the fourth and fifth wrist cables708, 710 are released. The tension applied to the third cable 706 pullsthe first major jaw 110A to the left, while the tension applied to thesixth cable 712 pulls the second major jaw 110B to the right. Thus, thejaws 110A, 110B are pulled towards each other and towards a closedposition.

When the first and second handle levers 602A, 602B are moved away fromone another, the fourth wrist cable 708 is wrapped further onto thelower pulley 624A of the first handle lever 602A, and the fifth wristcable 710 is wrapped further onto the upper pulley 620B of the secondhandle lever 602B. At the same time, the third wrist cable 706 ispartially unwrapped from the upper pulley 620A of the first handle lever602A, and the sixth wrist cable 712 is partially unwrapped from thelower pulley 624B of the second handle lever 602B. In other words, thefourth and fifth wrist cables 708, 710 are pulled while the third andsixth wrist cables 706, 712 are released. The tension applied to thefourth cable 708 pulls the first major jaw 110A to the right, while thetension applied to the fifth cable 710 pulls the second major jaw 110Bto the left. Thus, the jaws 110A, 110B are pulled away from each otherand towards an open position.

Tension Compensation

When yaw movement of the proximal wrist assembly 500 occurs, tensionapplied and/or removed from the third, fourth, fifth, and sixth wristcables 706, 708, 710, 712 adjusts the yaw of the end effector assembly108. This yaw movement of the proximal wrist assembly 500 can alsoproduce incidental movement of the first and second wrist cables 702,704 which, if not compensated for, could introduce unintended changes inthe effective length of the first and second wrist cables 702, 704, andcorresponding pitch adjustments of the end effector assembly 108. Inother words, unless some compensation is provided, yaw movement of themaster component can produce unintended pitch movement of the slavecomponent, in addition to the intended yaw movement.

Similarly, when pitch movement of the proximal wrist assembly 500occurs, tension applied and/or removed from the first and second wristcables 702, 704 adjusts the pitch of the end effector assembly 108. Thispitch movement of the proximal wrist assembly 500 can also produceincidental movement of the third, fourth, fifth, and sixth wrist cables706, 708, 710, 712 which, if not compensated for, could introduceunintended changes in the effective length of these cables, andcorresponding yaw adjustments of the end effector assembly 108. In otherwords, unless some compensation is provided, pitch movement of themaster component can produce unintended yaw movement of the slavecomponent, in addition to the intended pitch movement.

The device 10 can compensate for incidental movement of “non-active”pitch cables by running the first and second cables 702, 704 through thecentral pulley system 508 twice in opposite directions. Thus, referringfor example to FIGS. 14A-14B, when yaw movement occurs that wouldotherwise tend to apply incidental tension to the first cable 702, thefirst cable 702 is simultaneously wrapped onto one of the minor pulleys572D, 572B of the pitch pivot pin 542 and unwrapped from another of theminor pulleys 572D, 572B of the pitch pivot pin 542. The first cable 702is also simultaneously wrapped onto one of the minor pulleys 568A, 568Bon the yaw pivot pin 526 and unwrapped from another of the minor pulleys568A, 568B on the yaw pivot pin 526. Accordingly, the net movement ofthe distal terminal end 702 d of the first cable 702 is zero. In otherwords, as the pulley 560-2U pulls the cable 702 out of the centralpulley system 508 during yaw articulation, the pulley 560-1U feeds thecable 702 back into the central pulley system, and vice versa. The sameis true for the second cable 704. This prevents inadvertent pitchmovement when only yaw movement is intended.

As noted above, the minor pulleys over which the first and second cables702, 704 are wound can have a diameter that is one half the diameter ofthe major pulleys over which the third, fourth, fifth, and sixth cables706, 708, 710, 712 are wound. This prevents the routing of the first andsecond cables through the central pulley system 508 twice from scalingpitch movement differently from yaw movement. In other words, if thepulleys were the same size, yaw of the master would be mapped 1:1 to theslave, whereas pitch movement of the master would be mapped 2:1 to theslave by virtue of the first and second cables being wrapped over twiceas much pulley radius as the third, fourth, fifth, and sixth cables.

The device 10 can also compensate for incidental movement of“non-active” yaw cables during pitch articulation. Referring for exampleto FIGS. 16A-16B, when pitch movement occurs that would otherwise tendto apply incidental tension to the third cable 706, the third cable 706is simultaneously wrapped onto one of the major pulleys 570D of thepitch pivot pin 542 and unwrapped from one of the guide pulleys 106C ofthe pitch pivot pin 124. In other words, as the cable 706 wraps onto thepulley 570D during pitch movement of the handle assembly 600, the pitchof the distal wrist assembly 100 changes, causing the cable 706 tounwrap from the guide pulley 106C. Similarly, as the cable 706 unwrapsfrom the pulley 570D during pitch movement of the handle assembly 600 inthe opposite direction, the pitch of the distal wrist assembly 100changes in the opposite direction, causing the cable 706 to wrap ontothe guide pulley 106C. Accordingly, the net movement of the distalterminal end 706 d of the third cable 706 is zero in either case. Thisprevents inadvertent yaw movement when only pitch movement is intended.A similar effect occurs with the fourth, fifth, and sixth cables 708,710, 712.

Elbow Cables and Operation

As noted above, the six wrist cables can control up-down pivotingmovement (pitch) of the slave components, left-right pivoting movement(yaw) of the slave components, and actuation of the slave components(opening and closing of the end effector jaws). The three elbow cables,on the other hand, can control up-down translational movement (heave) ofthe slave components and left-right translational movement (sway) of theslave components.

The three elbow cables 714, 716, 718 can extend from the proximal elbowplate 206 p of the distal elbow assembly 200, through the body assembly300, to the tension plate 432 of the proximal elbow assembly 400.

The paths of each of the three elbow cables 714, 716, 718 are describedin detail below. For clarity of illustration, a number of components ofthe device 10 are not shown in the figures that accompany thisdescription. For example, in the figures corresponding to eachparticular cable, all other cables are not shown. Also, for clarity ofillustration, the proximal elbow plate 206 p and the tension plate 432are shown in close proximity to one another, however it will beappreciated that in fact these components can be separated in thelongitudinal direction by the body assembly 300 and other interveningcomponents of the device 10, as described above.

The first elbow cable 714 is shown in FIG. 21A. As shown, the terminaldistal end 714 d of the cable is coupled to a first attachment point onthe proximal elbow plate 206 p of the distal elbow assembly 200. Theterminal proximal end 714 p of the cable 714 is coupled to a firstattachment point on the tension plate 432 (e.g., a first tension screw434A). As shown, the first attachment point on the proximal elbow plate206 p is rotationally offset 180 degrees from the first attachment pointon the tension plate 432.

The second elbow cable 716 is shown in FIG. 21B. As shown, the terminaldistal end 716 d of the cable 716 is coupled to a second attachmentpoint on the proximal elbow plate 206 p of the distal elbow assembly200. The terminal proximal end 716 p of the cable 716 is coupled to asecond attachment point on the tension plate 432 (e.g., a second tensionscrew 434B). Again, the second attachment point on the proximal elbowplate 206 p is rotationally offset 180 degrees from the secondattachment point on the tension plate 432.

The third elbow cable 718 is shown in FIG. 21C. As shown, the terminaldistal end 718 d of the cable 718 is coupled to a third attachment pointon the proximal elbow plate 206 p of the distal elbow assembly 200. Theterminal proximal end 718 p of the cable is coupled to a thirdattachment point on the tension plate 432 (e.g., a third tension screw434C). Again, the third attachment point on the proximal elbow plate 206p is rotationally offset 180 degrees from the third attachment point onthe tension plate 432.

The three attachment points on the proximal elbow plate 206 p are spaced120 degrees apart from one another about the circumference of the plate,as are the three attachment points on the tension plate 432. Theproximal elbow plate 206 p is positioned such that it is rotatedapproximately 60 degrees relative to the tension plate 432. Accordingly,the cables 714, 716, 718 are coupled to proximal and distal attachmentpoints that are offset 180 degrees from one another. This 180 degreerotational offset in attachment points causes the elbow cables to “crossover” as they extend through the body assembly 300 and other interveningcomponents of the device 10. This crossing of attachment points producesmirrored motion between the distal elbow assembly 200 and the proximalelbow assembly 400, which in turn produces mimicked translational motionbetween the end effector assembly 108 and the handle assembly 600.

FIG. 22 schematically illustrates the cable interconnection between theproximal and distal elbow assemblies 200, 400. For clarity ofillustration, the proximal retainer housing 202 p of the distal elbowassembly 200 and the distal retainer housing 402 d of the proximal elbowassembly 400 are shown in phantom. In addition, the proximal and distalelbow assemblies 200, 400 are shown in close proximity to one another,even though in fact they can be separated in the longitudinal directionby the body assembly 300 and other intervening components of the device10, as described above. As shown, when the handle assembly 600 istranslated downwards (e.g., a downward heave motion), the proximalretainer housing 402 p of the proximal elbow assembly 400 moveslaterally relative to the distal retainer housing 402 d of the proximalelbow assembly 400. This causes the cone rods 410 to pivot in theconcavities in which they are received, such that the cone rods tiltrelative to the proximal and distal retainer housings 402 p, 402 d. Thetension plate 432 tilts with the cone rods, which pulls on the secondand third cables 716, 718 while simultaneously releasing the first cable714.

The pulling of the second and third cables 716, 718 causes the lowerportion of the proximal elbow plate 206 p of the distal elbow assembly200 to tilt towards the proximal retainer housing 202 p of the distalelbow assembly 200. Meanwhile, the releasing of the first cable 714allows the upper portion of the proximal elbow plate 206 p to tilt awayfrom the proximal retainer housing 202 p. Accordingly, the proximalelbow plate 206 p tilts relative to the proximal retainer housing 202 p,causing the cone rods 210 to tilt in a similar fashion. This causes thedistal retainer housing 202 d to translate downwards, such that thedistal elbow assembly 200 mirrors the proximal elbow assembly 400 andmimicked downward heave is achieved. Thus, the mirrored relationshipbetween the proximal and distal elbow assemblies allows for heave andsway of the proximal retainer housing 402 p to be mimicked by heave andsway of the distal retainer housing 202 d.

Other Features

Some cables can be prone to stretching or contracting over time or whentension is applied thereto. This can introduce movement error into thesystem, particularly when cables extend over a long distance.Accordingly, one or more of the wrist cables and/or elbow cables caninclude an anti-stretch bracing, as shown in FIG. 23. The anti-stretchbracing 720 can be in the form of a stretch-resistant member 722 that isfixedly attached to a cable C at at least two points 724, 726. Forexample, a rigid tube through which the cable is passed can be crimpedat its proximal and distal ends to first and second points along thelength of the cable. Since the rigid tube does not stretch or contractsubstantially, the cable is prevented from stretching or contractingbetween the first and second points. Any length of any cable of thedevice 10 can include an anti-stretch bracing. In one embodiment, all ofthe wrist cables and all of the elbow cables include an anti-stretchbracing along substantially the entire portion of the cable that extendsthrough the body assembly 300.

As shown in FIG. 24, the device 10 can also include one or more lockingmechanisms. In the illustrated embodiment, the locking mechanism 728 isin the form of a rigid tubular housing 730 slidably disposed over thebody assembly 300 and proximal elbow assembly 400. When the lockingmechanism 728 is placed in a “locked” position, as shown in FIG. 24, thetubular housing 730 can maintain the tension plate 432 of the proximalelbow assembly 400 in a position that is parallel to the distal retainerhousing 402 d of the proximal elbow assembly 400. This locks theproximal elbow assembly 400 and prevents up-down translational movement(heave) and left-right translational movement (sway) of the handleassembly 600 relative to the body assembly 300. The locking mechanism728 can also be slid distally along the body assembly 300 to an“unlocked” position, in which the tension plate 432 and the rest of theproximal elbow assembly 400 are positioned outside of the tubularhousing 730. In this position, the proximal elbow assembly 400 can befree to move such that heave and sway of the handle assembly 600 ispermitted. The locking mechanism 728 can be coupled to the body assembly300 so as to limit its range of longitudinal motion, and can include oneor more biasing springs or other elements to bias it towards either thelocked or unlocked configuration.

The device 10 can also include a mechanism for locking the proximalwrist assembly 500 (e.g., a second tubular housing that can slide overone or more of the distal, central, and proximal wrist frames 502, 504,506, maintaining them in longitudinal alignment). While the illustratedlocking mechanism 728 includes a tubular housing 730, other lockingmechanisms can also be employed, such as locking pins, straps, screws,or cables. Such locking mechanisms can be configured to lock the variousjoints of the device 10 in a non-articulated position, in afully-articulated position, and/or in any intermediate positiontherebetween.

The inclusion of one or more locking mechanisms can allow the device tofunction in a plurality of different “modes” of operation, in whichvarious degrees of freedom are restricted. Some users are morecomfortable with a rigid tool like a traditional laparoscopic tooland/or do not need several degrees of freedom for certain procedures orfor certain aspects of procedures. Thus, for these users, the lockingmechanism can be selectively engaged to limit the degrees of freedom inwhich the end effector assembly can be moved. When extra degrees offreedom are desired or necessary (e.g., during a knot tying or suturingoperation), the locking mechanism can be disengaged to restore completefreedom of movement. It will also be appreciated that, if surge and rollcapabilities are not required, the body assembly 300 can be coupleddirectly to the frame 22 without the linear bearing 20, therebyeliminating these degrees of freedom. This ability to change operatingmodes on the fly prevents the user from having to change tools in themiddle of a procedure.

It will thus be appreciated that one or more locking mechanisms can beprovided to allow the device 10 to be locked in any of a varietyconfigurations. One exemplary configuration is a “hook” configuration inwhich the wrist joint is locked in an articulated position, the jaws arelocked in a closed position, and the elbow assembly is locked in anon-articulated position. The hook configuration can be useful forperforming tissue dissection and for “hooking” and pulling tissue duringdissection. Another exemplary operating mode is a “right angle”configuration, which is the same as the hook configuration except thatthe jaws are not locked. The right angle configuration can be useful forspreading or dissecting tissue that is “behind” an important structuresuch as a vessel or cystic duct. Selectively locking or unlocking theelbow joint in either of these configurations can allow for a hook orright angle configuration that is customized to the specific anatomy ortask at hand. This is also useful for single site surgery to reduceinstrument clashing and increase triangulation. Another exemplaryconfiguration is a “wristed straight stick” configuration in which theelbow joint is locked and the jaws and wrist joint remain unlocked. Thisconfiguration can provide increased ability to grasp and dissect atdifferent angles compared to non-wristed straight stick. A variation onthis configuration is one in which the wrist joint is partially locked(e.g., such that yaw movement of the wrist joint is allowed while pitchmovement is prevented, or such that pitch movement of the wrist joint isallowed while yaw movement is prevented).

Although mimicked motion is obtained in the illustrated embodiments,mirrored motion or some combination of the two can also be achieved byreversing the direction in which cables are wound around pulleys,reversing the mapping of cables to handle pulleys, running the elbowcables straight through the device instead of crossing them, etc.

In some embodiments, it can be desirable to scale motion and/oractuation of the device.

A movement ratio can be defined as the ratio of the magnitude of mastercomponent movement to the magnitude of slave component movement. Inother words, a movement ratio of 5:1 would mean that a 5 mm movement ofthe master component would be necessary to achieve a 1 mm movement ofthe slave component. Large movement ratios can advantageously absorbsmall movements, insulating the slave component from slight tremors orshaking introduced at the master component. Small movement ratios canadvantageously reduce surgeon fatigue by minimizing the degree to whichthey must move the master component. In addition, movement ratios thatare less than 1:1 (e.g., 0.5:1) can achieve motion beyond the angulationlimits of the human wrist without requiring complex clutchingmechanisms. In other words, a 1 mm movement of the master component canbe scaled to a greater than 1 mm movement at the slave component toeffectively increase the angulation range of a human user.

An actuation ratio can be defined as the ratio of the magnitude ofactuation applied to the master component to the magnitude of actuationexperienced at the slave component. A high actuation ratio can allow formore precise actuation control at the slave component, whereas a lowactuation ratio can reduce surgeon fatigue by limiting the actuationinput required at the master component.

Because the pivot axis of the handle levers 602A, 602B (which controlactuation) and the yaw pivot axis of the proximal wrist assembly 500(which controls movement) are offset from one another, the movementratio and the actuation ratio of the device 10 can be adjustedindependently of one another. For example, the diameter of the handlepulleys 620A, 620B, 624A, 624B can be decreased to obtain a higheractuation ratio without affecting the movement ratio. Similarly, thediameter of the pulleys in the central pulley system 508 can bedecreased to obtain a higher movement ratio without affecting theactuation ratio.

Progressive scaling can also be achieved by forming an eccentric portionon the circumference of the pulleys (e.g., such that the pulleys havethe shape of a cam lobe). This can allow for an initial movement ratioor actuation ratio that increases or decreases as the pulley rotates(i.e., as the cable is wrapped over the eccentric portion).

The device 10 can also include a frame assembly 800, as shown in FIGS.25A-25C. The frame assembly 800 can be positioned between the bodyassembly 300 and the proximal elbow assembly 400 such that the proximalelbow assembly 400, proximal wrist assembly 500, and handle assembly 600can be flipped 180 degrees in the proximal-distal direction relative tothe body assembly 300. The frame assembly 800 can include first andsecond C-shaped side plates 802, 804 and a plurality of pulley housings806, 808, 810, 812 sandwiched therebetween. Each pulley housing 806,808, 810, 812 can include one or more pulleys mounted to one or morepulley axles for routing the wrist cables 702, 704, 706, 708, 710, 712and elbow cables 714, 716, 718 through the frame assembly 800 from theproximal elbow assembly 400 to the body assembly 300.

The frame assembly 800 can act as a handle for providing the fixed frameof reference, such that the device 10 can operate with six degrees offreedom even without being coupled to the linear bearing 20 and/orstationary frame 22.

Also, without the frame assembly 800, the movement of the distal“tethered” end of handle assembly 600 is mimicked by the distal “free”end of the end effector assembly 108. With the frame assembly 800,movement of the formerly-proximal “free” end of the handle assembly 600is mimicked by the distal “free” end of the end effector 108 assembly,which some users might find to be more natural. To obtain this mimickedmotion when the frame assembly 800 is included, the wrist cable routingcan be swapped at one end of the device 10. For example, the first wristcable 702 can be routed through the proximal wrist assembly 500following the path usually followed by the second wrist cable 704, whilethe second wrist cable 704 can be routed through the proximal wristassembly 200 following the path usually followed by the first wristcable 702. The third wrist cable 706 can be similarly swapped with thesixth wrist cable 712 and the fourth wrist cable 708 can be similarlyswapped with the fifth wrist cable 710.

As will be appreciated by those skilled in the art, any and all of theembodiments disclosed herein can be interchangeable with one another asneeded. In addition, the devices disclosed herein can be designed to bedisposed of after a single use, or they can be designed to be usedmultiple times. In either case, however, the device can be reconditionedfor reuse after at least one use. Reconditioning can include anycombination of the steps of disassembly of the device, followed bycleaning or replacement of particular pieces, and subsequent reassembly.In particular, the device can be disassembled, and any number of theparticular pieces or parts of the device can be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, the device can be reassembled for subsequent useeither at a reconditioning facility, or by a surgical team immediatelyprior to a surgical procedure. Those skilled in the art will appreciatethat reconditioning of a device can utilize a variety of techniques fordisassembly, cleaning/replacement, and reassembly. Use of suchtechniques, and the resulting reconditioned device, are all within thescope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that the device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

The invention claimed is:
 1. A surgical device, comprising: a handle; anelongate tubular body having an inner lumen extending therethrough; anend effector located distal to the elongate tubular body and configuredto engage tissue; a first plurality of cables extending from the handle,extending through the inner lumen of the elongate tubular body, andbeing operatively coupled to the end effector; and a second, differentplurality of cables extending from the handle, extending through theinner lumen of the elongate tubular body, and being operatively coupledto the end effector; wherein: pitch movement of the handle relative tothe elongate tubular body is configured to cause movement of the firstplurality of cables and thereby move the end effector in pitch movementcorresponding to the pitch movement of the handle; yaw movement of thehandle relative to the elongate tubular body is configured to causemovement of the first plurality of cables and thereby move the endeffector in yaw movement corresponding to the yaw movement of thehandle; heave movement of the handle relative to the elongate tubularbody is configured to cause movement of the second plurality of cablesand thereby move the end effector in heave movement corresponding to theheave movement of the handle; and sway movement of the handle relativeto the elongate tubular body is configured to cause movement of thesecond plurality of cables and thereby move the end effector in swaymovement corresponding to the sway movement of the handle.
 2. The deviceof claim 1, wherein the pitch movement of the handle includes the handlepivoting at a first pivot joint proximal to the elongate tubular body;the pitch movement of the end effector includes the end effectorpivoting at a second pivot joint distal to the elongate tubular body;the yaw movement of the handle includes the handle pivoting at a thirdpivot joint proximal to the elongate tubular body; and the yaw movementof the end effector includes the end effector pivoting at a fourth pivotjoint distal to the elongate tubular body.
 3. The device of claim 1,wherein the pitch movement of the handle and the yaw movement of thehandle do not cause movement of the second plurality of cables, and theheave movement of the handle and the sway movement of the handle do notcause movement of the first plurality of cables.
 4. The device of claim1, wherein the end effector includes first and second jaws configured toengage tissue therebetween; and the handle is configured to be actuatedand thereby cause movement of the first plurality of cables that causesthe first and second jaws of the end effector to selectively open andclose.
 5. The device of claim 1, further comprising a plurality ofdistal pulleys adjacent the end effector; and a plurality of proximalpulleys adjacent the handle; wherein each of the plurality of distalpulleys receives one of the first plurality of cables, and each of theplurality of proximal pulleys receives one of the first plurality ofcables.
 6. The device of claim 5, wherein each of the second pluralityof cables are located entirely proximal to the plurality of distalpulleys and entirely distal to the plurality of proximal pulleys.
 7. Thedevice of claim 1, further comprising a proximal plate having proximalterminal ends of each of the second plurality of cables coupled thereto,the proximal plate having a hole formed therein through which the firstplurality of cables pass; and a distal plate having distal terminal endsof each of the second plurality of cables coupled thereto, the distalplate having a hole formed therein through which the first plurality ofcables pass.
 8. The device of claim 7, wherein the proximal plate is ata location proximal to the elongate tubular body and distal to thehandle, and the distal plate is at a location proximal to the endeffector and distal to the elongate tubular body.
 9. The device of claim7, wherein the heave movement of the handle causes movement of each ofthe proximal and distal plates relative to the elongate tubular body;and the sway movement of the handle causes movement of each of theproximal and distal plates relative to the elongate tubular body. 10.The device of claim 1, further comprising a plurality of proximalpulleys each receiving one of the first plurality of cables; a pluralityof distal pulleys each receiving one of the first plurality of cables; aproximal plate located proximal to the elongate tubular body, distal tothe plurality of proximal pulleys, and proximal to the plurality ofdistal pulleys, the proximal plate having the first plurality of cablesextending through a hole formed therein, and the proximal plate having aproximal terminal end of each of the second plurality of cables attachedthereto; and a distal plate located distal to the elongate tubular body,distal to the plurality of proximal pulleys, and proximal to theplurality of distal pulleys, the distal plate having the first pluralityof cables extending through a hole formed therein, and the distal platehaving a distal terminal end of each of the second plurality of cablesattached thereto.
 11. The device of claim 1, wherein the pitch movementof the end effector corresponding to the pitch movement of the handle ismirrored movement, mimicked movement, or a combination thereof; the yawmovement of the end effector corresponding to the yaw movement of thehandle is mirrored movement, mimicked movement, or a combinationthereof; the heave movement of the end effector corresponding to theheave movement of the handle is mirrored movement, mimicked movement, ora combination thereof; and the sway movement of the end effectorcorresponding to the sway movement of the handle is mirrored movement,mimicked movement, or a combination thereof.
 12. A surgical device,comprising: a handle; an elongate tubular body having an inner lumenextending therethrough; an end effector configured to engage tissue; afirst plurality of cables extending from a first plurality of pulleys,through the inner lumen of the elongate tubular body, and to a secondplurality of pulleys that each receive one of the first plurality ofcables, the first plurality of pulleys each receiving one of the firstplurality of cables and each being located proximal to the elongatetubular body, and the second plurality of pulleys being located distalto the elongate tubular body; and a second, different plurality ofcables extending from a proximal plate located distal to the firstplurality of pulleys, through the inner lumen of the elongate tubularbody, and to a distal plate located proximal to the second plurality ofpulleys, each of the first plurality of cables extending proximally anddistally of each of the proximal plate and the distal plate; wherein:pitch movement of the handle relative to the elongate tubular body isconfigured to cause movement of the first plurality of cables andthereby move the end effector in pitch movement corresponding to thepitch movement of the handle; yaw movement of the handle relative to theelongate tubular body is configured to cause movement of the firstplurality of cables and thereby move the end effector in yaw movementcorresponding to the yaw movement of the handle; heave movement of thehandle relative to the elongate tubular body is configured to causemovement of the second plurality of cables and movement of the proximaland distal plates and thereby move the end effector in heave movementcorresponding to the heave movement of the handle; and sway movement ofthe handle relative to the elongate tubular body is configured to causemovement of the second plurality of cables and movement of the proximaland distal plates and thereby move the end effector in sway movementcorresponding to the sway movement of the handle.
 13. The device ofclaim 12, wherein the pitch movement of the handle includes pivoting ofthe handle at a first pivot joint proximal to the elongate tubular body;the yaw movement of the handle includes pivoting of the handle at asecond pivot joint proximal to the elongate tubular body; the pitchmovement of the end effector includes pivoting of the end effector at athird pivot joint distal to the elongate tubular body; and the yawmovement of the end effector includes pivoting of the end effector at afourth pivot joint distal to the elongate tubular body.
 14. The deviceof claim 12, wherein the movement of the first plurality of cablescaused by the pitch movement of the handle includes translationalmovement of the first plurality of cables through a hole formed in theproximal plate and includes translational movement of the firstplurality of cables through a hole formed in the distal plate; and themovement of the first plurality of cables caused by the yaw movement ofthe handle includes translational movement of the first plurality ofcables through the hole formed in the proximal plate and includestranslational movement of the first plurality of cables through the holeformed in the distal plate.
 15. The device of claim 12, wherein themovement of the first plurality of cables does not cause movement of theproximal and distal plates.
 16. The device of claim 12, wherein thepitch movement of the end effector corresponding to the pitch movementof the handle is mirrored movement, mimicked movement, or a combinationthereof; the yaw movement of the end effector corresponding to the yawmovement of the handle is mirrored movement, mimicked movement, or acombination thereof; the heave movement of the end effectorcorresponding to the heave movement of the handle is mirrored movement,mimicked movement, or a combination thereof; and the sway movement ofthe end effector corresponding to the sway movement of the handle ismirrored movement, mimicked movement, or a combination thereof.